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Age-related differences in sepsis outcomes: A comparative analysis of elderly and very elderly ICU patients

Ozgur Kilic1, Enver Demircan2

1 Ondokuz Mayis University Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care, Samsun, Turkey
2 Ondokuz Mayis University Faculty of Medicine, Department of Internal Medicine, Samsun, Turkey

DOI: 10.2478/jccm-2025-0034

Background: The rapid aging of the global population has amplified the clinical and economic burden of sepsis, a leading cause of morbidity and mortality in the elderly. Within this demographic, the “very elderly” (≥80 years) represent a particularly vulnerable subgroup. This study evaluates and compares the outcomes and prognostic factors of elderly (65–79 years) and very elderly ICU patients with sepsis or septic shock.
Methods: A retrospective observational study was conducted in a single-center ICU, including 251 patients aged ≥65 years diagnosed with sepsis or septic shock. Patients were categorized as elderly (65–79 years, N=162) or very elderly (≥80 years, N=89). Data on demographics, comorbidities, laboratory results, infection sources, treatments, and outcomes were collected. Prognostic factors for mortality were analyzed using binary logistic regression.
Results: The very elderly group exhibited higher rates of dementia, immobility, and fungal infections, while malignancy was more prevalent in the elderly group. ICU length of stay was longer in the very elderly group (median 8 vs. 6 days, P=0.027). ICU mortality was lower in the very elderly group, showing a trend toward significance but not reaching statistical significance (70.8% vs. 82.1%, P=0.056). Shared predictors of mortality included higher SOFA scores, malignancy, hospital-acquired sepsis, invasive mechanical ventilation, and acute kidney injury.
Conclusion: This study highlights differences in sepsis outcomes between elderly and very elderly patients. The findings underscore the importance of developing and implementing age-specific management strategies to improve outcomes in these high-risk populations. These insights contribute to a more tailored and effective approach to geriatric critical care.

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Effect of the implementation of a selective digestive decontamination protocol in an intensive care unit

Rosario Fernández-Fernández1, Eugenia Yuste-Ossorio1, Natalia Chueca-García1, Purificación Fernández-Morales1, Rocio Morón-Romero1, Manuel Colmenero2

1 Hospital Universitario San Cecilio, Granada, Spain
2 Instituto de Investigación Biosanitaria, Granada, Spain

DOI: 10.2478/jccm-2025-0025

Introduction: The use of selective digestive decontamination (SDD) in critically ill patients remains controversial. The impact of antimicrobial resistance varies according to multiple factors attributed to the type of patient and the characteristics of intensive care units (ICU).
Aim of the study: to describe the effect of the implementation of a selective digestive decontamination protocol on the incidence of nosocomial infections and colonization of multidrug-resistant organisms (MDRO) in an intensive care unit.
Materials and methods: Prospective observational study in a general ICU of a University Hospital. All patients admitted for 2 years (divided into 1-year periods) before and after the implementation of the SDD were included. This intervention was performed in all patients who received invasive mechanical ventilation in the second period. Incidence density rates were determined for all nosocomial infections (per days of stay) and device-associated infections (per days of use), and risk ratio (RR) were calculated with 95% confidence intervals. Microbiological surveillance of the colonization status of patients was performed on admission and on a weekly basis. A univariate analysis was performed for comparison between groups. A p<0.05 was considered significant.
Results: A total of 1532 patients were included in the pre-intervention period (pre-SDD) and 1734 in the post-intervention period (post-SDD). The incidence of all infections decreased [9.21 vs 6.54 per days of stay; RR: 0,71 (0,428 – 1,172), p=0,16], although not significantly. Both catheter-related bacteremias and all catheter-related bacteremias together (primary and secondary) were significantly reduced [4.49 vs 0.71 per 1000 days of use; RR: 0,157 (0,017 – 0,723), p=0,006]. The colonization rates by MDRO also decreased (3.26% vs 2.36%), but not significantly.
Conclusions: Implementation of SDD significantly decreased the number of catheter-related bacteraemias, without an increase in MDRO colonization.

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Right ventricular failure after LVAD support: A challenging case of bridge to heart transplantation in end-stage dilated cardiomyopathy

Horatiu Suciu1,2, Emanuel-David Anitei2, Paul Calburean3, Marius Mihai Harpa1,2

1 Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2 Department of Cardiovascular Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
3 Department of Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania

DOI: 10.2478/jccm-2025-0038

Introduction: End-stage heart failure due to dilated cardiomyopathy remains a major indication for advanced mechanical circulatory support and heart transplantation. Left ventricular assist devices have emerged as a vital bridge to transplant, improving survival and functional status. However, right ventricular failure following LVAD implantation is a significant and potentially fatal complication, requiring careful management to optimize outcomes.
Case presentation: We present the case of a 46-year-old male with post-myocarditis dilated cardiomyopathy, severely reduced left ventricular ejection fraction (21%), severe functional mitral and tricuspid regurgitation, and NYHA class IV heart failure. Despite optimal medical therapy, including inotropic support, the patient progressed to multiorgan dysfunction necessitating renal replacement therapy. A HeartMate 3 LVAD was implanted as a bridge to transplantation. The postoperative course was complicated by severe right ventricular failure, requiring prolonged inotropic support and careful hemodynamic management. Despite these challenges, the patient successfully underwent orthotopic heart transplantation. His postoperative evolution was favorable, with stable graft function and good clinical recovery documented during follow-up.
Conclusion: Right ventricular failure remains a major complication following LVAD implantation, significantly impacting outcomes. While LVADs have revolutionized the management of end-stage heart failure, heart transplantation continues to represent the definitive therapy offering superior long-term survival.

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Latent class analysis to identify sub-phenotypes predicting pediatric splenic pseudoaneurysm following blunt spleen injuries: A post-hoc analysis

Yuki Kishihara1, Hideto Yasuda1–4, Morihiro Katsura5, Masahiro Kashiura1, Shunsuke Amagasa6, Yutaro Shinzato1, Yutaka Kondo7, Shigeki Kushimoto8, Takashi Moriya1

1 Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
2 Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
3 School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Australia
4 School of Nursing and Midwifery; Alliance for Vascular Access Teaching and Research, Griffith University, Australia
5 Department of Surgery, Okinawa Chubu Hospital, Okinawa, Japan
6 Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan
7 Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
8 Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan

DOI: 10.2478/jccm-2025-0037

Aim of the study: The rupture of delayed formed splenic pseudoaneurysms after pediatric blunt splenic injuries undergoing nonoperative management (NOM) can be life-threatening. We aimed to identify the sub-phenotypes predicting delayed splenic pseudoaneurysm formation following pediatric blunt splenic injury using latent class analysis (LCA).
Material and Methods: In this retrospective observational study conducted using a multicenter cohort of pediatric trauma patients, we included pediatric patients (aged ≤16 years) who sustained blunt splenic injuries and underwent NOM from 2008 to 2019. LCA was performed using clinically important variables, and 2–5 sub-phenotypes were identified. The optimal number of sub-phenotypes was determined on the basis of clinical importance and Bayesian information criterion. The association between sub-phenotyping and delayed splenic pseudoaneurysm formation was analyzed using univariate logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs).
Results: The LCA included 434 patients and identified three optimal sub-phenotypes. Contrast extravasation (CE) of initial CT in the spleen was observed in 22 patients (68.8%) in Sub-phenotype 1, 49 patients (25.7%) in Sub-phenotype 2, and 22 patients (10.4%) in Sub-phenotype 3 (p = 0.007). Delayed splenic pseudoaneurysm was observed in 46 patients (10.6%), including seven patients (21.9%) in Sub-phenotype 1, 25 patients (13.1%) in Sub-phenotype 2, and 14 patients (6.6%) in Sub-phenotype 3 (p = 0.01). Logistic regression analysis for delayed splenic pseudoaneurysm formation using Sub-phenotype 3 as the reference revealed an OR (95% CI) of 3.94 (1.45–10.7) in Sub-phenotype 1 and 2.12 (1.07–4.21) in Sub-phenotype 2.
Conclusions: The LCA identified three sub-phenotypes showing statistically significant differences for delayed splenic pseudoaneurysm formation. Our findings suggest that cases with CE on initial CT imaging may be at increased risk of delayed splenic pseudoaneurysm formation.

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Rethinking peer review in medicine: From trust to transformation

Dan Longrois¹, Sacha Rozencwaig², Pierre-Grégoire Guinot³

1 Departments of Anesthesiology and Intensive Care, Bichat-Claude Bernard and Louis Mourier Hospitals, Assistance Publique–Hôpitaux de Paris, University Paris Cité, INSERM 1148, Paris, France
² Anesthesiology and Perioperative Department, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris Saclay University, France
³ Department of Anesthesiology and Intensive Care, Dijon University Hospital, University of Burgundy, INSERM UMR1231, CTM Lipness Team, Dijon, France

DOI: 10.2478/jccm-2025-0035

At the heart of biomedical publishing integrity lies peer review—long regarded as the “gold standard” of scientific validation. Yet, despite its foundational role, peer review today reveals critical shortcomings: inconsistency, lack of transparency, slow turnaround, and susceptibility to bias. As the scientific landscape evolves with rising submission volumes, data complexity, and urgency for rapid knowledge dissemination, it is no longer enough to refine peer review; it must be reimagined.
As editors and long-time participants in academic publishing, we have consistently faced the challenges of writing, reviewing, and managing peer evaluations. Identifying qualified reviewers and synthesizing their feedback into fair editorial decisions remains a formidable task. This editorial outlines our concerns and envisions how artificial intelligence (AI) can enhance—not replace—peer review in medicine. Over 90% of the initial text was generated with ChatGPT Scholar using structured prompts; it has since been extensively revised by the authors. [More]

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Comparative analysis of COVID-19 critically ill patients across four pandemic waves in Greece

Stelios Kokkoris1, Aikaterini Goufa2, Dimitrios Tsilivarakis1, Fotios Kavallieratos1, Georgia Minatsi1, Despoina Papadaki1, Aikaterini Pranti1, Spyros Zakynthinos1, Anastasia Kotanidou1, Christina Routsi1

1 National and Kapodistrian University of Athens, Medical School, First Department of Critical Care Medicine, Evangelismos Hospital, Athens, Greece
2 National and Kapodistrian University of Athens, First Department of Medicine, Laiko General Hospital, Athens, Greece

DOI: 10.2478/jccm-2025-0036

Introduction: There is limited information about trends in mortality of intensive care unit (ICU) patients with Coronavirus Disease-2019 (COVID-19) throughout the entire pandemic period.
Aim: We compared the ICU mortality among the four consecutive waves of the pandemic, according to the virus variant predominance.
Methods: This is a retrospective study of prospectively collected data extracted from our COVID-19 clinical database. All adult patients with confirmed SARS-CoV-2 infection, consecutively admitted to our ICU from March 2020 through April 2022, were included. For the analysis we used the dates of the four periods of the pandemic, according to the predominance of different SARS-CoV-2 variants in Greece. Kaplan-Meier and Cox proportional hazards analyses were used.
Results: In total, 805 patients [median (IQR) age 67 (56-76) years, 68% males] were included. APACHE II, Charlson, and SOFA scores were 14 (11-19), 3 (2-5) and 7 (4-9), respectively; 674 (84%) patients required invasive mechanical ventilation. ICU length of stay was 15 (8-29) days, and mechanical ventilation duration was 11 (4-24) days. ICU and hospital mortality was 48% and 54%, respectively. Kaplan-Meier survival curves revealed no significant differences in ICU mortality among the four waves. Age, malignancy, chronic pulmonary disease and SOFA score were independent predictors of ICU mortality, but the pandemic waves themselves were not. Age had a significant impact on ICU mortality across all waves.
Conclusion: The effect of COVID-19 wave (and consequently of the SARS- CoV-2 variant) on ICU mortality seems to be trivial, and therefore our focus should be shifted to other risk factors, such as age and comorbidities. These findings along with those of other studies could be useful for modelling the evolution of future outbreaks.

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Incidental hyperglycemia and myocardial infarction risk in non-diabetic patients in the emergency department: A retrospective cohort analysis

Erkan Boğa

Ministry of Health of Turkey, Istanbul, Turkey

DOI: 10.2478/jccm-2025-0033

Objective: This study investigated whether incidental hyperglycemia serves as an independent risk factor for myocardial infarction (MI) among non-diabetic patients in the emergency department.
Methods: A retrospective case-control study analyzed data from one thousand non-diabetic patients aged 18-85 years who visited the emergency department during January through October two thousand twenty-four Patients were classified into two equal groups based on their random blood glucose levels: patients with glucose levels above 140 mg/dL formed the hyperglycemia group and patients with glucose levels below 140 mg/dL belonged to the normoglycemia group. The analysis employed logistic regression to assess how hyperglycemia related to MI while controlling for various demographic and clinical variables.
Results: The incidence of MI was found in 61.4% of patients with hyperglycemia but only in 25.8% of patients with normoglycemia. Multivariable analysis revealed that incidental hyperglycemia increased the odds of MI by 2.42 times. The risk was higher among male patients and further increased when glucose levels exceeded 180 mg/dL.
Conclusions: Non-diabetic emergency department patients who experience incidental hyperglycemia show a high risk of developing MI. The evaluation of cardiovascular risk should begin with emergency physicians, who should consider elevated random blood glucose as a potential marker for identifying patients likely to benefit from early assessment and follow-up.

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Artificial intelligence algorithms based approach in evaluating COVID-19 patients and management

Ioana Hălmaciu1, Anca Meda Văsieșiu2, Andrei Manea1,3, Andrei Dragomir3, Ioana Tripon4, Vlad Vunvulea5, Cristian Boeriu6, Andrea Rus7, Minodora Dobreanu8,9

1 Department of Radiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2 Department of Infectious Diseases, George Emil Palade University of Medicine Pharmacy Science, and Technology of Targu Mures, Targu Mures, Romania
3 Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
4 Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
5 Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
6 Department of Emergency Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
7 Department of Radiology, Clinical Emergency County Hospital of Targu Mureș, Targu Mures, Romania
8 Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
9 Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/jccm-2025-0032

Introduction: COVID-19 pneumonia manifests with a wide range of clinical symptoms, from minor flu-like signs to multi-organ failure. Chest computed tomography (CT) is the most effective imaging method for assessing the extent of the pulmonary lesions and correlates with disease severity. Increased workloads during the COVID-19 pandemic led to the development of various artificial intelligence tools to enable quicker diagnoses and quantitative evaluations of the lesions.
Aim of the study: This study aims to analyse the correlation between lung lesions identified on CT scans and the biological inflammatory markers assessed, to establish the survival rate among patients.
Methods: This retrospective study included 120 patients diagnosed with moderate to severe COVID-19 pneumonia who were admitted to the intensive care unit and the internal medicine department between September 2020 and October 2021. Each patient underwent a chest CT scan, which was subsequently analysed by two radiologists and an AI post-processing software. On the same day, blood was collected from the patients to determine inflammatory markers. The markers analysed in this study include the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio, platelet-lymphocyte ratio, systemic immune-inflammatory index, systemic inflammation response index, systemic inflammation index, and serum interleukin-6 value.
Results: There were strong and very strong correlations between the derived inflammatory markers, interleukin-6, and the CT severity scores obtained by the AI algorithm (r=0.851, p<0.001 in the case of NLR). Higher values of the inflammatory markers and high lung opacity scores correlated with a decreased survival rate. Crazy paving was also associated with an increased risk of mortality (OR=2.89, p=0.006).
Conclusions: AI-based chest CT analysis plays a crucial role in assessing patients with COVID-19 pneumonia. When combined with inflammatory markers, it provides a reliable and objective method for evaluating COVID-19 pneumonia, enhancing the accuracy of diagnosis.

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Exploring pharmacological strategies in the management of ARDS: Efficacy, limitations, and future directions

Sultan Almuntashiri

Department of Clinical Pharmacy, College of Pharmacy, University of Ha’il, Ha’il, Saudi Arabia

DOI: 10.2478/jccm-2025-0030

Acute respiratory distress syndrome (ARDS) is a severe inflammatory reaction in the lungs caused by sudden pulmonary and systemic injuries. Clinically, this diverse syndrome is marked by sudden hypoxemic respiratory failure and the presence of bilateral lung infiltrates visible on a chest X-ray. ARDS management remains largely supportive, with a focus on optimizing mechanical ventilation strategies and addressing the underlying causes of lung injury. The current pharmacological approach for ARDS primarily focuses on corticosteroids, neuromuscular blocking agents, and beta-2 agonists, however, none has been definitively proven to be consistently effective in improving clinical outcomes. This review summarizes the latest evidence regarding the effectiveness and limitations of these pharmacological interventions, identifying key areas where further research is needed.

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