Category Archives: Original Research

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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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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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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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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