Category Archives: Editorial

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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Challenges in Management of the Brain-Dead Organ Donor During the COVID-19 Pandemic

Ioana Marina Grințescu

“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

DOI: 10.2478/jccm-2021-0013

Starting in Wuhan, China [1], the infection caused by the novel SARS-CoV-2 virus became a public health issue when, due to the extreme contagiousness of this virus, a pandemic has been declared [2], putting a strain on both the global medical staff as well as the authorities in an effort to better manage an unprecedented situation in the modern era. Looking at the society we are living in, we can easily see that the COVID-19 pandemic has brought impressive social, economic, political, cultural and medical changes as well as personal ones; I believe that the perspectives and priorities of many of us have changed.
Before discussing the transplant activity, mainly the one regarding diagnosis and maintenance of the brain-dead organ donor patient, an activity that has been carried out for many years in Anesthesiology and Intensive Care Clinics, to which many of us are devoted, practicing it with deep respect, we need to review the daily activity. As is well known, the work effort in intensive care units is extremely demanding both mentally and physically. It involves the care of critical patients with severe decompensated pathologies, requiring maximum therapeutic management, special attention, continuous specific monitoring as well as the use of advanced medical and pharmacological techniques. The new measures and regulations, personal protective equipment, structural changes and working protocols implemented to prevent and limit COVID-19 infection, as well as the rigors imposed by the care of these patients have created additional stress for the medical staff. [More]

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Reflections on a Year of SARS-CoV-2

Elisabeth Abeles, Razvan Azamfirei

Johns Hopkins University School of Medicine, Baltimore, MD, USA

DOI: 10.2478/jccm-2021-0005

As we are writing this editorial 12 months following the publication of “The 2019 Novel Coronavirus: A Crown Jewel of Pandemics?”, there are 96 million cases with over 2 million total deaths, a public health tragedy of staggering proportions [1]. The early stages of the pandemic were characterized by scientific uncertainty, with many authors postulating hypotheses about the transmission of SARS-CoV-2, the appropriate medical treatment, and the most effective public health measures. In retrospect, many of the early takes on coronavirus ended up being incorrect. Since January 2020, science has advanced at a breathtaking pace and the disease caused by SARS-CoV-2 has taken on dimensions few of us anticipated. In this piece, we aim to reflect on the last year, discussing aspects of the pandemic that the scientific community correctly anticipated, and highlighting where we went wrong. [More]

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Hemoadsorption in Critical Care – It Is a Useful or a Harmful Technique?

Judit Kovacs

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

DOI: 10.2478/jccm-2020-0036

Since ancient times it has been known that elimination of toxins from the body helps to relieve symptoms, heal patients; for that hot baths, sweating techniques, enemas, and phlebotomy were used in the treatment of severe diseases.
Blood purification is still practiced today, but using modern techniques. The theoretical basis for the elimination of toxins by osmosis and dialysis through a semipermeable membrane was laid by Thomas Graham in the 19th century, but the first “artificial kidney”, was built and used successfully by Kolff only in 1943, in patients with acute renal failure.
Since then, blood purification has developed a lot, today it is possible to eliminate endo- and exotoxins in acute and chronic renal failure, liver failure, intoxications with various substances, but also the elimination of mediators formed in excess in sepsis and systemic inflammatory syndrome of other etiologies, and elimination of immune complexes in autoimmune and graft versus host diseases.

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Mechanical Ventilation – A Friend in Need?

Bianca-Liana Grigorescu

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

DOI: 10.2478/jccm-2020-0027

The development of modern medicine has imposed a new approach both in anaesthesiology and in intensive care. This is the reason why, in the last decades, more and more devices and life-support techniques were improved in order to achieve the highest medical outcomes.
Key features of the critically ill patient are severe respiratory, cardiovascular or neurological derangements, often in combination, reflected in abnormal physiological observations. All these changes converge towards the establishment of pulmonary or extrapulmonary respiratory failure requiring mechanical ventilatory support. In the current conception, mechanical ventilation does not represent a curative method for respiratory pathology, however, it represents a bridge therapy ensuring the rest and preservation of respiratory muscles, improves gas exchange and assists in maintaining a normal pH until the recovery of the patient [1].
Despite decades of research, there are limited therapeutic options directed towards the underlying pathological processes and supportive care with mechanical ventilation remaining the cornerstone of patient management. [More]

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Therapeutic Plasma Exchange: An Indispensable Therapy for Severe Neurological Conditions

Rodica Balasa

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

DOI: 10.2478/jccm-2020-0021

Therapeutic plasma exchange (TPE) is the most frequent therapeutic apheresis procedure used to remove the plasma, together with its high-molecular-weight agents such as immune complexes, antibodies, complement components, cytokines, different toxins and cryoglobulins, as well as to return of the majority of cellular components to the patients [1]. In the hands of an experienced specialist, TPE has been found by the American Academy of Neurology to be a very important and safe tool that can improve neurological disability in patients with numerous disorders [2]. [More]

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The 2019 Novel Coronavirus: A Crown Jewel of Pandemics?

Razvan Azamfirei

Johns Hopkins School of Medicine, Baltimore, MD, USA

DOI: 10.2478/jccm-2020-0013

Starting from the December 2019 identification of the 2019 novel coronavirus (2019-nCoV), an overwhelming sense of panic has enveloped public discourse. This is likely to be amplified by WHO recently declaring the novel coronavirus outbreak a public health emergency of international concern. It is the third significant occurrence of a zoonotic coronavirus crossing the species barrier to infect humans, and it likely will not be the last. Hope is not lost; and a measured approach, one that is cognizant of the seriousness of this public health crisis without giving into hysteria, is imperative. [More]

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