Category Archives: Editorial

The Human Microbiome in Intensive Care – A Journey Forward?

Leonard Azamfirei

Department of Anesthesia and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania

DOI: 10.2478/jccm-2023-0032

The human microbiome, defined as a personal, genomic signature of our latent or manifest infectious profile (bacterial, viral, fungal), located predominantly in the digestive tract, opens the door to personalized medicine studies on a scale larger than the human genome in terms of data that can be analyzed and interpreted. Compared to the human genome, which has approximately 23,000 genes, the European Metagenomics of the Human Intestinal Tract and the Human Microbiome Project have reported 3.3 million non-redundant microbial genes [1]. [More]

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Fluid Therapy from Friend to Foe

Raluca Fodor

Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2023-0019

The general management of shock, or any syndrome characterized by inadequate tissue perfusion involves identifying and addressing the underlying cause while also reversing the disorder produced in any of the 4 components of the cardiovascular system (blood and fluid compartment, vascular system, heart and circulatory system) [1] through combined therapeutic methods that are based on rapid volume resuscitation, usually pursuing target goals. Although the “salvage, optimization, stabilization, de-escalation” mnemonic has been utilized as a broad framework for volume resuscitation since 2016 [2], the approach to fluid therapy in critically ill patients remains inconsistent with current clinical practice, contingent upon the practices adopted by individual healthcare institutions. [More]

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Artificial Intelligence: The Next Blockbuster Drug in Critical Care?

Razvan Azamfirei

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

DOI: 10.2478/jccm-2023-0017

The realm of critical care medicine is always waiting for the game-changing innovation – that elusive breakthrough poised to dramatically transform practice and yield remarkable results. Various contenders have come and gone: surfactant therapy, synthetic colloids, drotrecogin alfa [1-3]. While some have been consigned to the annals of history, a select few, such as low-tidal-volume ventilation, have endured [4]. Others re-emerge time and again, hoping that they’ll have an evidence-based role somewhere. The level of excitement is not always correlated with the staying power of the innovation, and sometimes the hype can overshadow the reality. [More]

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Rebranding Nutritional Care for Critically Ill Patients

Liliana Elena Mirea, Cristian Cobilinschi, Ioana Marina Grințescu

Anaesthesia and Intensive Care Clinic, Clinical Emergency Hospital of Bucharest
“Carol Davila” University of General Medicine, Bucharest

DOI: 10.2478/jccm-2023-0008

Since the organic and molecular roles and function of nutrients in supporting homeostasis for hospitalized patients have been already stated, remarkable advances have been achieved in the field of clinical nutrition [1]. Replacing the old terminology of “nutritional support” with the new concept of “nutritional therapy” both European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Enteral and Parenteral Nutrition (ASPEN) emphasized that adequate nutrients administration reduces oxidative stress, metabolic response and sustains the immune response [1, 2]. The persistently increased prevalence of hospital malnutrition, inappropriate nutritional support during hospitalisation contributes undeniably to an increased mortality, especially in intensive care units [3].
In order to promote the importance of nutritional care and increase awareness among authorities and clinicians, “The International Declaration on the Human Right to Nutritional Care” was adopted during ESPEN Congress 2022 in Vienna. This Declaration highlights that nutritional therapy is a human right in the same manner as the right to food and health [4]. Moreover, all the undersigned societies, including Romanian Society of Enteral and Parenteral Nutrition (ROSPEN), raise awareness of the high prevalence of disease-related malnutrition along with the lack of access to appropriate nutritional support during and after hospitalisation. [More]

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In between Opioid Crisis and the Need to Treat Pain, Where Do We Stand?

Daniela Ionescu1, Simona Margarit2

1 Department of Anesthesia and Intensive Care I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2 Department of Anesthesia and Intensive Care, O Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania

DOI: 10.2478/jccm-2022-0029

Acute and chronic pain are very disturbing conditions for the patient, with numerous implications on the short- and long-term outcome of patients [1]. While acute pain is experienced mostly after surgery, and in some other medical conditions as well, chronic pain may be the symptom or the result of numerous medical conditions among which cancer, muscle-skeletal or neurodegenerative diseases and surgery or persistent inflammation are, probably, the main causes [2].
This is why guidelines, drugs and medical interventions have been proposed to treat acute and chronic pain [3, 4]. While acute pain, both mild or severe is well manageable with treatment, chronic pain may be very disturbing and debilitating for the patients, especially in patients with cancer, neurodegenerative or muscle-skeletal disorders and is generally much more difficult to treat [5]. [More]

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Personalized Physiological Medicine as the Future of Intensive Care Medicine

Leonard Azamfirei

Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mures, Romania

DOI: 10.2478/jccm-2022-0020

Personalized medicine has become increasingly popular over the last decade as a response to the variability of patients’ responses to certain medical or technological therapies [1]. The effectiveness of randomized controlled trials has become increasingly controversial. While personalized medicine came to be associated with the field of oncology, critically ill patients have also become a beneficiary of personalized medicine. Patients admitted to the intensive care unit have a series of multiple and intricate dysfunctions as well as complex and rapidly changing pathophysiological mechanisms underlying their disease. That is the background from which the concept of personalized physiological medicine (PPM) emerged. It is directly related to the therapy needs of a patient and their physiological status, determined by a certain genetic profile and characterized by biomarkers, specific to the individual and not exclusive to the disease [2-4]. Monitoring of organs becomes insufficient without continuous monitoring of microcirculation, cell metabolism, and the entire cellular functionality; the translation of these dynamic data into quantifiable parameters requires predominantly in vivo monitoring. [More]

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Dubito ergo sum. Pathologies that can mimic sepsis

Bianca-Liana Grigorescu

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

DOI: 10.2478/jccm-2022-0011

Sepsis is a potentially deadly organ dysfunction caused by a dysregulated host response to infection, with a high mortality rate [1]. Generally, sepsis is acquired in the community, and its development is slow, making diagnosis challenging. Early broad-spectrum antibiotics and effective source management improve prognosis [1, 2].
Sepsis has a huge financial impact on the health-care system; septic patient treatment in the United States alone is projected to cost more than $20 billion per year. The cost in human life is equally high; mortality rates in sepsis and septic shock are believed to be more than 10% and 40%, respectively [3]. Sepsis is one of the most prevalent causes for admission to the intensive care unit (ICU) and the leading cause of mortality in ICUs across the globe [3, 4]. [More]

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Target Controlled Infusion: An Anaesthetic Technique Brought in ICU

Janos Szederjesi

Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, Romania

DOI: 10.2478/jccm-2022-0001

Target Controlled Infusion (TCI) represents a technique of intravenous anaesthetic drug administration where we aim a predictable concentration of the drug in a specific body compartment.
The technique uses a computer-controlled infusion pump which delivers the anaesthetic drugs based on patient’s parameters (height, weight, age, gender and others) in order to achieve a predicted plasmatic level (TCIp) or a specific site (brain) (TCIe) [1].
The main advantage of the system consists in theoretical calculations and application of precise doses. TCI is designed upon the three-compartmental pharmacokinetic model, maintaining the same level of sedation, and avoiding drugs accumulation. This delivery method could also reduce the intra-operative awareness, emphasising on patient safety. However, the practice showed that those theoretical facts may not be easily applied into clinical practice [2].[More]

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Should We Go “Regional” in Intensive Care?

Alexandra Lazar

Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2021-0042

Pain is one of the major concerns in Intensive Care Units (ICU). The majority of the patients admitted in ICU experience a certain degree of pain during their stay. Opioid analgesia constitutes the main analgesic option for ICU patients [1].
Opioids are known to have serious side effects, some of them such as ileus, respiratory depression, which leads to prolonged mechanical ventilation, can interfere with the patient’s outcome can lengthen the stay in ICU and leads to iatrogenic withdrawal syndrome (IWS) [1, 2]. In the last few years, a new concept of pain management in ICU patients was introduced: opioid free analgesia (OFA). This concept implies achieving good quality analgesia without using any type of opioids, in any manner [3]. [More]

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Hypothalamic-pituitary axis disorder – “the puppet master” of multiple organ dysfunction in brain-dead patients

Bianca-Liana Grigorescu

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

DOI: 10.2478/jccm-2021-0029

One of the most revolutionary discoveries of modern medicine was organ transplantation, as it brought hope and healing in cases that seemed incurable. Best outcomes in organ transplantation are related to a rigorous tissue typing and an appropriate immunosuppressant therapy that allowed a longer survival rate for recipients [1]. The management of the potential brain-dead donor is a complex one that involves several well-defined stages: early identification of potential donors, brain death determination, maintaining vital functions, and graft transplantation.
Brain death determination is synonymous with irreversible anatomical and functional injury to the entire brain and brainstem. This process involves a major alteration of the hemodynamic and hormonal homeostasis. Hypothalamic irreversible injury is followed by a profound normothermia dysregulation. The aggressive inflammatory response after brain death occurrence is responsible for capillary leakage and refractory hypotension [2]. Clinical diagnostic tests that assess brain death include brain stem areflexia, apnea, and cerebral unresponsiveness, linked with a known, irreversible cause of coma [3].[More]

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