21st century critical care medicine:An overview

Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of innovation.Recent advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of therapies.The objective is to describe the recent advancements in Critical Care Medicine.Telemedicine:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely interventions.Artificial intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical decision-making.Organ Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support.Infection Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections.Ventilation Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung injury.Sepsis Management:Early recognition and aggressive management of sepsis with tailored interventions.Patient-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical needs.We conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative synthesis.To ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.These advancements reflect a dynamic landscape in critical care medicine,where technology,research,and patient-centered approaches converge to improve the quality of care and save lives in ICUs.The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.

New Year's greeting and overview of World Journal of Critical Care Medicine in 2021

As editors of World Journal of Critical Care Medicine(WJCCM),it is our great pleasure to take this opportunity to wish all our authors,subscribers,readers,Editorial Board members,independent expert referees,and staff of the Editorial Office a Very Happy New Year.On behalf of the Editorial Team,we would like to express our gratitude to all authors who have contributed their valuable manuscripts and to the independent referees and our subscribers and readers for their continuous support,dedication,and encouragement.The excellent team effort by our editorial board members and staff of the Editorial Office allowed WJCCM to advance remarkably in 2020.In the future,the Baishideng Publishing Group and WJCCM’s editorial board will continue to increase their communication and collaboration,both internally and involving our external contributors,in order to promote our collective impact on the field of Critical Care Medicine even further.

Critical care medicine in China： history and perspective

Critical care medicine began in 1982 in China and is still in a phase of rapid development. Despite theinadequate resources compared with-those of developed countries, critical care medicine has been recognized as a specialty by the government and by other specialties. National critical care societies are dedicated to promoting professional education and the academic improvement of critical care medicine in China. Although critical care services and clinical research are still underdeveloped due to scarce resources, great improvement is expected in the near future.

Critical Care Medicine 2017： Bigger Picture, Better Future

A lot of new progress has been made in critical care medicine during 2016, including the new definition of Sepsis-3, the tburth revision of the SttrvivhTg Sepsis Guidelines presenting, increasing using of point-of-care ultrasonography and so on. Furthermore, the critical care fields trend to be more precise, more evidence-based.

Journal of Intensive Medicine:A leading forum for breakthroughs and progress in critical care medicine

Dear Readers,Critical care medicine is a discipline that was established in the early 1980s in China.Nearly 40 years later,its importance is widely recognized and it has been developed as a second-tier discipline with its own systems of clinical practice,teaching,and research.Critical care medicine has seen rapid progress in the last decade and has played an important role in emerging public health events,and is expected to further evolve in the post-pandemic era.

Development of a prediction model for enteral feeding intolerance in intensive care unit patients:A prospective cohort study

BACKGROUND Enteral nutrition(EN)is essential for critically ill patients.However,some patients will have enteral feeding intolerance(EFI)in the process of EN.AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.METHODS A prospective cohort study was performed.The enrolled patients’basic information,medical status,nutritional support,and gastrointestinal(GI)symptoms were recorded.The baseline data and influencing factors were compared.Logistic regression analysis was used to establish the model,and the bootstrap resampling method was used to conduct internal validation.RESULTS The sample cohort included 203 patients,and 37.93%of the patients were diagnosed with EFI.After the final regression analysis,age,GI disease,early feeding,mechanical ventilation before EN started,and abnormal serum sodium were identified.In the internal validation,500 bootstrap resample samples were performed,and the area under the curve was 0.70(95%CI:0.63-0.77).CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.

Problems associated with glucose toxicity:Role of hyperglycemia-induced oxidative stress

Glucose homeostasis deficiency leads to a chronic increase in blood glucose concentration. In contrast to physiological glucose concentration, chronic super-physiological glucose concentration negatively affects a large number of organs and tissues. Glucose toxicity means a decrease in insulin secretion and an increase in insulin resistance due to chronic hyperglycemia. It is now generally accepted that glucose toxicity is involved in the worsening of diabetes by affecting the secretion of B-cells. Several mechanisms have been proposed to explain the adverse effects of hyperglycemia. It was found that persistent hyperglycemia caused the functional decline of neutrophils. Infection is thus the main problem resulting from glucose toxicity in the acute phase. In other words, continued hyperglycemia is a life-threatening risk factor, not only in the chronic but also the acute phase, and it becomes a risk factor for infection, particularly in the perioperative period.

Relationship of calcitonin gene-related peptide with disease progression and prognosis of patients with severe traumatic brain injury

Calcitonin gene-related peptide（CGRP） has been implicated in multiple functions across many bioprocesses; however, whether CGRP is associated with severe traumatic brain injury（TBI） remains poorly understood. In this study, 96 adult patients with TBI（enrolled from September 2015 to December 2016） were divided into a mild/moderate TBI group（36 males and 25 females, aged 38 ± 13 years） and severe TBI group（22 males and 13 females, aged 38 ± 11 years） according to Glasgow Coma Scale scores. In addition, 25 healthy individuals were selected as controls（15 males and 10 females, aged 39 ± 13 years）. Radioimmunoassay was used to detect serum levels of CGRP and endothelin-1 at admission and at 12, 24, 48, 72 hours, and 7 days after admission. CGRP levels were remarkably lower, but endothelin-1 levels were obviously higher in the severe TBI group compared with mild/moderate TBI and control groups. Levels of CGRP were remarkably lower, but endothelin-1 levels were obviously higher in deceased patients compared with patients who survived. Survival analysis and logistic regression showed that both CGRP and endothelin-1 levels were associated with patient mortality, with each serving as an independent risk factor for 6-month mortality of severe TBI patients. Moreover, TBI patients with lower serum CGRP levels had a higher risk of death. Thus, our retrospective analysis demonstrates the potential utility of CGRP as a new biomarker, monitoring method, and therapeutic target for TBI.

Special features of SARS-CoV-2 in daily practice

The severe acute respiratory syndrome-coronavirus-2(commonly known as SARS-CoV-2)is a novel coronavirus(designated as 2019-nCoV),which was isolated for the first time after the Chinese health authorities reported a cluster of pneumonia cases in Wuhan,China in December 2019.Optimal management of the Coronavirus Disease-2019 disease is evolving quickly and treatment guidelines,based on scientific evidence and experts’opinions with clinical experience,are constantly being updated.On January 30,2020,the World Health Organization declared the SARS-CoV-2 outbreak as a"Public Health Emergency of International Concern".The total lack of immune protection brought about a severe spread of the contagion all over the world.For this reason,diagnostic tools,patient management and therapeutic approaches have been tested along the way,in the desperate race to break free from the widespread infection and its fatal respiratory complications.Current medical knowledge and research on severe and critical patients’management and experimental treatments are still evolving,but several protocols on minimizing risk of infection among the general population,patients and healthcare workers have been approved and diffused by International Health Authorities.

Management of decompensated liver cirrhosis in the surgical intensive care unit

Liver cirrhosis is the end-stage of chronic progressive liver diseases(1).The most common causes of cirrhosis worldwide include alcohol-related liver disease,non-alcoholic fatty liver disease,hepatitis B,hepatitis C,autoimmune liver diseases(e.g.,autoimmune hepatitis),cholestatic liver diseases(e.g.,primary biliary cholangitis,primary sclerosing cholangitis),hemochromatosis or Wilsons’disease(1).

Evaluation of ICUs and weight of quality control indicators:an exploratory study based on Chinese ICU quality data from 2015 to 2020

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit(ICU)patients in Chinese mainland over six years(2015–2020).The data for this study were from 31 provincial and municipal hospitals(3425 hospital ICUs)and included 2110685 ICU patients,for a total of 27607376 ICU hospitalization days.We found that 15 initially established quality control indicators were good predictors of patient prognosis,including percentage of ICU patients out of all inpatients(%),percentage of ICU bed occupancy of total inpatient bed occupancy(%),percentage of all ICU inpatients with an APACHE II score≥15(%),three-hour(surviving sepsis campaign)SSC bundle compliance(%),six-hour SSC bundle compliance(%),rate of microbe detection before antibiotics(%),percentage of drug deep venous thrombosis(DVT)prophylaxis(%),percentage of unplanned endotracheal extubations(%),percentage of patients reintubated within 48 hours(%),unplanned transfers to the ICU(%),48-h ICU readmission rate(%),ventilator associated pneumonia(VAP)(per 1000 ventilator days),catheter related blood stream infection(CRBSI)(per 1000 catheter days),catheter-associated urinary tract infections(CAUTI)(per 1000 catheter days),in-hospital mortality(%).When exploratory factor analysis was applied,the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation:nosocomial infection management(21.35%),compliance with the Surviving Sepsis Campaign guidelines(17.97%),ICU resources(17.46%),airway management(15.53%),prevention of deep-vein thrombosis(14.07%),and severity of patient condition(13.61%).Based on the different weights of the core elements associated with the 15 indicators,we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management+17.97%xcompliance with SSC guidelines+17.46%×ICU resources+15.53%×airway management+14.07%×DVT prevention+13.61%×severity of patient condition.This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.

Let’s wish JIM a long and brilliant life!

Dear Readers,Today is a great day;Journal of Intensive Medicine is born.You can just call it JIM.You must be wondering why we are launch-ing a new journal since so many means of disseminating scien-tific information all over the world already exist.Compared to 15 years ago,hundreds of new medical journals have emerged and social media has developed rapidly.As soon as medical in-formation deemed important is revealed,it is immediately dis-seminated and,in a few seconds,relayed on social networks.With the worldwide use of smartphones,tablets and computers,it is difficult these days for the medical community members to miss important information.Therefore,you may wonder why we are launching a new medical journal dedicated to critical care medicine.The following points should help you to under-stand our approach.