Author Archives: administrare

Warburg effect in B-cell lymphoma: A case report and proposed management plan

Stefan Gligor, Salim Abdelhamid, Veronika Ballova, Andrea Kopp Lugli

Baden Cantonal Hospital, Baden, Switzerland

DOI: 10.2478/jccm-2025-0045

Introduction: The Warburg effect is a rare but often fatal condition in patients with malignancies. This phenomenon, known as type B lactic acidosis, is defined by lactatemia without tissue hypoxia or hypoperfusion, in contrast to type A lactic acidosis, which usually results from either or both.
Case presentation: A male patient in his seventies with a newly diagnosed diffuse large B-cell lymphoma is admitted to the intensive care unit due to severe metabolic derangements with hypoglycemia and lactatemia. Extensive investigations ruled out alternative etiologies, strongly suggesting the Warburg effects as the underlying mechanism. Despite hemodynamic instability, chemotherapy was initiated and resulted in initial clinical improvement.
Conclusion: We propose a stepwise approach to improve the management of patients with suspected type B lactic acidosis.

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Incidence rate of post-intensive care syndrome-family in Japan: A post-hoc analysis of a prospective observational study

Akihiro Takaba1, Masaaki Sakuraya1, Daisuke Kawakami2, Shigeki Fujitani3

1 JA Hiroshima Koseiren Hiroshima General Hospital, Hiroshima, Japan
2 Iizuka Hospital, Iizuka, Japan
3 St Marianna University School of Medicine, Kawasaki, Japan

DOI: 10.2478/jccm-2025-0042

Background: Family members in intensive care units (ICUs) may develop post-intensive care syndrome-family (PICS-F), characterized by psychiatric disorders such as anxiety, depression, and post-traumatic stress disorders (PTSD). A previous study reported that approximately 13% of patient families in Japan develop PICS-F symptoms six months following ICU discharge, which is lower compared to other countries. However, this figure may be underestimated by administrative claims data in Japan. Although clinical guidelines recommend interventions to prevent PICS-F, the implementation rate of these interventions in Japan remains unclear. This study addresses the epidemiology of PICS-F among family members of ICU survivors and the implementation of interventions for preventing PICS-F in Japan.
Methods: A post-hoc analysis of a prospective multicenter cohort study was conducted, focusing on mechanically ventilated ICU survivors and their closest relatives. This study covered 16 ICUs in 14 hospitals between April 2019 and September 2020, using questionnaires to assess the PICS-F symptoms among relatives using the Hospital Anxiety (HADS-A) and Depression (HADS-D) Scale and the Impact of Event Scale-Revised (IES-R). The implementation rate of interventions to prevent PICS-F was also evaluated.
Results: Of the 151 surveyed relatives, 104 relatives were assessed after 6 months. Notably, PICS-F was identified among 45.2% of relatives, with depression (36.5%), anxiety (31.7%), and PTSD (24.0%). Relatives with PICS-F were less likely to maintain their original employment compared to those without (61.3% vs 85.3%, P=0.047). While 63.5% of relatives received at least one preventive intervention during the ICU stay, more than one-third received none.
Conclusions: The incidence of PICS-F in Japan is higher than previously reported, affecting nearly half of patient relatives. Moreover, the implementation rate of interventions to prevent PICS-F is low. These findings suggest the need for reinforced socioeconomic support.

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Complication patterns and postoperative outcomes in surgical patients admitted to intensive care units

Caroline Tolentino Sanches, Silvia Paulino Ribeiro Albanese, Monique Elen Robuste, Gabriela Gomes da Silva, Marcos Toshiyuki Tanita, Cintia Grion

Universidade Estadual de Londrina, Londrina, Brazil

DOI: 10.2478/jccm-2025-0044

Objective: To analyze the frequency and types of postoperative complications and risk factors for in-hospital mortality.
Methods: This retrospective longitudinal study included adult patients who underwent surgical procedures and were admitted to the intensive care unit of a university hospital between March and July 2022. Study variables included sociodemographic, clinical, and epidemiological data; postoperative complications and hospital outcomes. The significance level was set at 5%.
Results: We analyzed 202 patients, with a median age of 67 years (IQR 55–74) and a predominance of males (62.4%). Inhospital mortality was 26.2%. Postoperative complications occurred in 84.7% of patients, with cardiovascular (53.4%), infectious (49.5%), and gastrointestinal (48.5%) complications being the most frequent. Early postoperative feeding was initiated in 34.2% of cases, and a delay was associated with a higher risk of complications. Nausea and vomiting prophylaxis were administered to most patients—intraoperatively in 61.9% and postoperatively in 96%. In logistic regression analysis, female sex, urgent surgery, and higher SAPS 3 scores were identified as independent risk factors for death.
Conclusions: Postoperative complications were highly prevalent and associated with an increased risk of death. Intraoperative nausea and vomiting prophylaxis and early postoperative feeding were associated with a lower frequency of complications. Identified risk factors for mortality included female sex, higher SAPS 3 scores, and urgent surgeries.

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Evaluation of PRVC and SIMV ventilation techniques on hemodynamic metrics and arterial blood gases in ICU patients with multiple trauma: A randomized, triple-blind study

Majid Vatankhah Tarbebar1, Saeed Kashani1, Fatemeh Darsareh1, Tayyebeh Zarei1, Bibi Mona Razavi1, Latifeh Farzanfar2, Mehrdad Sayadinia1, Pourya Adibi1, Mansour Shabani1, Mehrdad Malekshoar1, Milad Mohammadi1

1 Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
2 Student Research Committee, Faculty of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

DOI: 10.2478/jccm-2025-0043

Background: In the Intensive Care Unit (ICU), mechanical ventilation is frequently employed to assist critically injured patients with breathing. The two conventional methods are SIMV and PRVC. This research sought to evaluate these techniques, particularly concerning patient stability and the preservation of optimal blood gas levels.
Methods: We carried out a parallel-group, randomized, triple-blind clinical trial. One hundred two patients with multiple traumas admitted to the ICU were randomly allocated to either the SIMV group or the PRVC mode group. The main outcome was measured through blood hemodynamic parameters, blood pressure, and heart rate in mechanically ventilated patients with multiple traumas. The secondary outcome measured was the composition of arterial blood gases (pH, PaCO2, PaO2, HCO3, and SpO2).
Result: The average age in the SIMV and PRVC groups was 38.53±16.29 and 38.04±15.26 years, respectively, showing no statistical significance. Arterial blood gas parameters, including arterial blood pH, PaCO2, PaO2, HCO3, and SpO2, were similar in the SIMV and PRVC groups at the beginning of admission and 8 and 12 hours after admission, and there was no significant difference. Comparing vital signs including blood pressure (systolic, diastolic, and mean arterial pressure) and heart rate was similar in the SIMV and PRVC groups at the beginning of admission and 8 and 12 hours after admission.
Conclusion: No significant justification was identified to favor one approach over the other for trauma patients receiving ventilatory support. Both groups stayed consistent regarding vital signs and other health indicators.

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Nurses’ attitudes and knowledge about organ donation and transplantation in closed hospital wards

Anastasios Tzenalis1, Elpida Kontesidou2, George Kipourgos3, Evangelia Andreopoulou3, Angelikh Gkotsi3, Eleni Albani1

1 University of Patras, Patra, Greece
2 General Hospital Papageorgiou, Thessaloniki, Greece
3 University General Hospital of Patras, Patra, Greece

DOI: 10.2478/jccm-2025-0041

Objective: Nurses in closed hospital wards, such as Intensive Care and isolation units, play a pivotal role in identifying potential donors and supporting families during sensitive decision-making moments. However, gaps in knowledge or negative attitudes among nurses can hinder donation efforts. This study aims to explore the knowledge and attitudes of closed-ward nurses regarding organ donation and transplantation, providing insights to enhance education, advocacy, and clinical practices in these critical settings.
Methods: Modern analysis was performed on the data collected from questionnaires distributed to nurses of … General Hospital. The study involved 108 nurses. The questionnaire used to collect the data was provided by the Department of Social Work of the … University and distributed in electronic form to hospital nurses.
Results: After analyzing the nurses’ responses, it emerged that 85.19% of nurses are positive about the idea of organ donation and declare themselves willing to become donors, motivated by their will to really help their fellow human beings. In contrast, 5.56% said they would not be willing to donate. The main cause of their refusal seems to be fear and the prejudices they have, but also the fact that there is no trust in the organizations responsible for transplants. Finally, regarding the knowledge of the nurses who participated in the survey, the average knowledge score on the scale 0-100 is 72.
Conclusions: There is a clear need for specialized training for nurses managing organ donation. The emotional burden and responsibilities they face are significant. Enhanced training supports their well-being and ensures a more compassionate, efficient process for donors and families, ultimately improving the experience for all involved.

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Severe acute respiratory syndrome coronavirus 2 infection and West Nile encephalitis in a patient with chronic kidney disease

Vince Akos Andrejkovits1, Alexandra Ioana Asztalos2, Nina Ioana Bodnar1, Erzsebet Iringo Zaharia-Kezdi1, Anca Meda Vasiesiu1

1 George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Romania
2 Mures County Clinical Hospital, Targu Mures, Romania

DOI: 10.2478/jccm-2025-0040

Objective: We describe a peculiar combination of West Nile virus (WNV) and SARS-CoV-2 infection, suggesting crucial clinical implications for diagnosis and management.
Case report: We present a case of a 57-year-old woman with a past medical history of end-stage renal disease (ESRD), on chronic hemodialysis, and arterial hypertension. She was admitted to the hospital for a 5-day history of fever, headache, vomiting, psychomotor slowing, a diffuse tremor on the four limbs, and diarrhea. Evaluation revealed the presence of neutrophilic leukocytosis, hemoglobin level of 10.5g/dL, elevated C-reactive protein (60 mg/L), serum creatinine of 13.4 mg/dL with hyperkaliemia. Neurologic examination described the following findings: neck stiffness, confusion with motor aphasia, bradylalia, bradypsychia, global hyperreflexia, diffuse tremor, and unstable gait. Brain CT described a calcified temporo-lateral meningioma, CSF examination revealed colorless appearing, 560 leucocytes/3microL (97% lymphocytes), 848 mg/L proteins, glycorrhachia: 54 mg/dL (serum glucose: 101 mg/dL), and the multiplex Real-Time PCR test result was negative. On the second day of admission, the patient tested positive for COVID-19 and she was commenced on therapy with remdesivir, ceftriaxone, dexamethasone, and clexane. Adequate hemodialysis sessions were performed. On the eighth day of admission, the diagnosis of WNV infection was made based on the positive serological findings and the presence of IgM antibodies in the cerebrospinal fluid. After 15 days of hospitalization, the patient was discharged in good clinical condition, except for mild tremor in her limbs.
Conclusions: Periodic epidemic bursts of WNV infection have been reported in Mures County, but present coinfection is rare; the severity and prognosis of the disease are unforeseeable.

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Severe acute respiratory distress syndrome in a woman infected with Ascaris lumbricoides

Alexandra Elena Lazar­, Mihai Claudiu Pui

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2025-0039

Acute Respiratory Distress Syndrome [ARDS] is a critical condition characterized by severe respiratory failure due to widespread lung inflammation, which can arise from various causes including trauma, infections, and systemic diseases. Among the rare causes is infection with Ascaris lumbricoides, a helminth typically affecting the gastrointestinal tract but capable of causing severe respiratory complications. We present the case of a 41-year-old woman with acute respiratory distress and negative viral and bacterial tests, who was ultimately diagnosed with Ascaris lumbricoides-induced ARDS. Her management included mechanical ventilation, antimicrobial therapy, corticosteroids, and eventually anthelmintic treatment after discovering the parasite. Despite initial deterioration and severe hypoxemia, the patient improved significantly following anthelmintic therapy, allowing extubation on day 8 and ICU discharge on day 12. Helminth-induced ARDS, though rare, should be considered in critically ill patients, especially in endemic regions. Early identification and appropriate therapy can dramatically improve outcomes.

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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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