Field Of Critical Care Medicine Research Articles

Bibliometric Analysis of Studies on Delirium in Critical Care

Background Delirium leads to prolongation in intensive care unit (ICU) and hospital length of stay and an increase in ICU costs and mortality. As a result of this, the number of studies on delirium in ICUs has recently increased significantly, and many articles have been published. Objectives The aim of this study was to evaluate the articles related to “delirium” in “critical care” field in the Web of Science database and the first hundred most cited articles on this subject. Methods The Web of Science database was searched for articles relevant to “delirium” in the critical care medicine field published between 1980 and 2024. Text analytics and network models used in bibliometric mapping were used for prolific authors, annual trend, citation, and countries. Results In our study, it was determined that a total of 1834 articles in the field of delirium in critical care medicine were included. It was determined that the annual citation average was 42.79 and the H-index value was 134. There is a general upward trend over the years, and it was observed that it has intensified in the last 5 to 6 years. With the Reference Spectroscopy analysis, it was determined that the most intensively cited studies on delirium were the studies of 2013 and 2010. The distribution of keywords in recent years has focused on analgosedation, acute brain injury, older patient, COVID-19, and fragility. When examined for the top 100 cited articles, it was seen that mobilization, guidelines, pain, activities of daily living, anesthesia, sedation, and haloperidol have become prominent in recent years. Conclusion In recent years, there has been a noticeable increase in the volume of research focusing on delirium studies within the field of critical care medicine. Staying current with trends, incorporating findings from frequently cited studies, and customizing interventions to suit modern difficulties can all improve the quality of care offered to critically ill patients and lead to better outcomes.

Expert consensus on clinical practice of parenteral nutrition therapy for critically ill patients in China (2024)

Critical patients have a high incidence of malnutrition, which can lead to adverse outcomes such as infections and ICU-acquired weakness. Improving the nutritional status of critically ill patients is currently an important challenge. Parenteral nutrition (PN) is an important component of medical nutrition, but there is still much controversy over how to implement a reasonable and standardized PN for critically ill patients. To further standardize the PN strategy for critically ill patients, the Critical Care Medicine Branch of the Zhejiang Medical Association convened experts in the field of critical care medicine and formulated the Expert consensus on clinical practice of parenteral nutrition therapy for critically ill patients in China (2024). This consensus is based on the GRADE evidence quality grading standard, problem oriented, and summarizes evidence-based medicine evidence from multiple aspects such as PN timing, suitable population, nutritional plan, and ingredient ratio, providing professional suggestions for the standardization and implementation of PN in clinical nutrition practice.

Perioperative use of high flow nasal cannula

High flow nasal cannula (HFNC) is an innovative oxygen therapy system that has gained increasing popularity in recent decades, particularly in the field of critical care medicine. The device provides a more constant and higher FiO2, generates low levels of PEEP, reduces dead space ventilation, and conditions the inspired gas, which collectively results in a reduction in work of breathing (WOB) and improved patient comfort. While the application of HFNC in critically ill patients is well-established and supported by a large body of evidence, studies of HFNC during the perioperative period are limited. However, the working mechanisms of HFNC align with physiological demands across various anesthetic processes. Consequently, this system could potentially serve as an alternative oxygen delivery system for surgical patients during perioperative care. In this article, we summarize the working principles and the effects provided by HFNC, review its implementation during the perioperative period, and discuss the current evidence regarding its use.

Impact of Sedation Protocols on Elderly Patients Undergoing Mechanical Ventilation and Off-Line Weaning

The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.

Harnessing Big Data in Critical Care: Exploring a new European Dataset

Freely available datasets have become an invaluable tool to propel data-driven research, especially in the field of critical care medicine. However, the number of datasets available is limited. This leads to the repeated reuse of datasets, inherently increasing the risk of selection bias. Additionally, the need arose to validate insights derived from one dataset with another. In 2023, the Salzburg Intensive Care database (SICdb) was introduced. SICdb offers insights in currently 27,386 intensive care admissions from 21,583 patients. It contains cases of general and surgical intensive care from all disciplines. Amongst others SICdb contains information about: diagnosis, therapies (including data on preceding surgeries), scoring, laboratory values, respiratory and vital signals, and configuration data. Data for SICdb (1.0.6) was collected at one single tertiary care institution of the Department of Anesthesiology and Intensive Care Medicine at the Salzburger Landesklinik (SALK) and Paracelsus Medical University (PMU) between 2013 and 2021. This article aims to elucidate on the characteristics of the dataset, the technical implementation, and provides analysis of its strengths and limitations.

Highlights in the clinical nutrition literature: A critical appraisal of current research.

Within the American Society for Parenteral and Enteral Nutrition (ASPEN), the Physician Engagement Committee (PEC) was created in 2017 by the ASPEN Board of Directors with the goal of growing the physician community both nationally and internationally. The PEC meets each month throughout the year to develop educational and research initiatives. In 2022, the PEC began an initiative to systematically review and evaluate practice-changing literature annually with the overall aim to highlight these studies at the annual ASPEN conferences and to critically discuss the potential clinical implications. The objective of the held meeting session was to present identified key papers in the fields of critical care medicine, gastroenterology and hepatology, and adult internal medicine that were published in 2022, which would complement the knowledge of the pathogenesis, diagnosis, and management of nutrition topics as well as to identify areas of future research. Overall, several large-scale randomized controlled studies were identified in each of these sections, with practice-changing major results. This manuscript summarizes the information that was presented and the discussions that followed.

Ultrasonography in the intensive care unit: a bibliometrics analysis.

Ultrasonography is widely used in critical care practice. The status of related studies remains unclear. The purpose of this study is to analyze current literature investigating the use of ultrasound in critical care units by using bibliometric analysis. The Science Citation Index Expanded (SCI-E) database was used for data retrieval. The search formula for literature retrieval was "ultrasound" OR "ultrasonography" AND "intensive care unit" OR "critical care unit" OR "intensive care" OR "critical care". The bibliometric software package of R software was used to analyze the results. Information of related literatures were analyzed. Finally, 3,715 articles were included. The number of published articles and the number of references increased annually. The research fields included medical imaging, critical care medicine, cardiology, etc. The United States has published more documents in this field than other countries and has shown the highest rate of cooperation with other countries. Among the top 10 research institutions with the largest number of publications, 5 are from France and 3 are from the United States. There are many authors from China in the top 10 published studies. Among the top 10 journals with the largest number of published articles, 5 journals are top journals in the field of critical care medicine. Among the top 10 keywords, there are 5 of ultrasound specialty and 2 of critical care medicine. Researches on the use of ultrasound in critical care units are mainly concentrated in several developed countries in Europe and the United States. Chinese research institutions should perform more studies in this field and increase cooperation with institutions from other countries.

Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review.

In the field of critical care medicine, substantial research efforts have focused on identifying high-risk patient groups. This research has led to the development of diverse diagnostic tools, ranging from basic biomarkers to complex indexes and predictive algorithms that integrate multiple methods. Given the ever-evolving landscape of medicine, driven by rapid advancements, changing treatment strategies, and emerging diseases, the development and validation of diagnostic tools remains an ongoing and dynamic process. Specific changes in complete blood count components, such as neutrophils, lymphocytes, monocytes, and platelets, are key immune system responses influenced by various factors and crucial in systemic inflammation, injury, and stress. It has been reported that indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and delta neutrophil index calculated using various ratios of these elements, are important predictors of various outcomes in conditions where the inflammatory process is at the forefront. In this narrative review, we concluded that NLR, PLR, SII, and SIRI show promise in predicting outcomes for different health conditions related to inflammation. While these tests are accessible, reliable, and cost-effective, their standalone predictive performance for a specific condition is limited.

A Machine Learning Algorithm Predicting Acute Kidney Injury in Intensive Care Unit Patients (NAVOY Acute Kidney Injury): Proof-of-Concept Study.

Acute kidney injury (AKI) represents a significant global health challenge, leading to increased patient distress and financial health care burdens. The development of AKI in intensive care unit (ICU) settings is linked to prolonged ICU stays, a heightened risk of long-term renal dysfunction, and elevated short- and long-term mortality rates. The current diagnostic approach for AKI is based on late indicators, such as elevated serum creatinine and decreased urine output, which can only detect AKI after renal injury has transpired. There are no treatments to reverse or restore renal function once AKI has developed, other than supportive care. Early prediction of AKI enables proactive management and may improve patient outcomes. The primary aim was to develop a machine learning algorithm, NAVOY Acute Kidney Injury, capable of predicting the onset of AKI in ICU patients using data routinely collected in ICU electronic health records. The ultimate goal was to create a clinical decision support tool that empowers ICU clinicians to proactively manage AKI and, consequently, enhance patient outcomes. We developed the NAVOY Acute Kidney Injury algorithm using a hybrid ensemble model, which combines the strengths of both a Random Forest (Leo Breiman and Adele Cutler) and an XGBoost model (Tianqi Chen). To ensure the accuracy of predictions, the algorithm used 22 clinical variables for hourly predictions of AKI as defined by the Kidney Disease: Improving Global Outcomes guidelines. Data for algorithm development were sourced from the Massachusetts Institute of Technology Lab for Computational Physiology Medical Information Mart for Intensive Care IV clinical database, focusing on ICU patients aged 18 years or older. The developed algorithm, NAVOY Acute Kidney Injury, uses 4 hours of input and can, with high accuracy, predict patients with a high risk of developing AKI 12 hours before onset. The prediction performance compares well with previously published prediction algorithms designed to predict AKI onset in accordance with Kidney Disease: Improving Global Outcomes diagnosis criteria, with an impressive area under the receiver operating characteristics curve (AUROC) of 0.91 and an area under the precision-recall curve (AUPRC) of 0.75. The algorithm's predictive performance was externally validated on an independent hold-out test data set, confirming its ability to predict AKI with exceptional accuracy. NAVOY Acute Kidney Injury is an important development in the field of critical care medicine. It offers the ability to predict the onset of AKI with high accuracy using only 4 hours of data routinely collected in ICU electronic health records. This early detection capability has the potential to strengthen patient monitoring and management, ultimately leading to improved patient outcomes. Furthermore, NAVOY Acute Kidney Injury has been granted Conformite Europeenne (CE)-marking, marking a significant milestone as the first CE-marked AKI prediction algorithm for commercial use in European ICUs.

Assessing the Impact of Blood Cancer Talks, a Novel ‘how I Treat’ Style Podcast on Hematologic Malignancies: A Survey-Based Analysis

Introduction: The advent of podcasts has revolutionized the field of medical education. Podcasts offer a portable and convenient format that accommodates the busy schedule of healthcare professionals and students alike. Initially popularized particularly in the field of critical care medicine and emergency medicine (Cadogan M et.al 2014), educational podcasts are now available across a wide range of medical specialties. We launched a new, independent, and free podcast dedicated to hematologic malignancies, named “ Blood Cancer Talks” in July 2022. The vision of our podcast is to deliver high quality educational content in a unique “ How I Treat” format, where we interview subspecialty experts in order to provide listeners clinically-relevant insights from world-leading content experts at the forefront of their respective areas across hematologic malignancies. We further seek to assess relevant recent updates, especially clinical trials, and incorporate critical appraisal of recent data and literature into our episodes. Methods: To gather honest and unbiased feedback from our listeners and to continue to refine our content and format for maximum impact and engagement, we deployed an anonymous survey using SurveyMonkey. The survey was distributed via Twitter and email. The survey had a total of 13 questions, of which 6 used a 5-point Likert scale (1, “strongly disagree” to 5, “strongly agree”; or 1, “poor” to 5, “excellent”). Results: The survey was open for 30 days (6/25-7/25/2023), and received a total of 36 responses. A majority of respondents were Attending Physicians (50%), and treated only patients with hematologic malignances (91.3%). Categories and locations of all respondents are shown in Figure 1. A majority of respondents (79%) learnt about the podcast on Twitter, followed by word of mouth (21%), followed by MashupMD (6%). The mean length of our episode was 51 minutes (range, 32-64). 92% of respondents perceived the length as “about right”, and 8% as “too long”. The overall quality of podcast was described as “excellent” by 21 (58%), “very good” by 11 (31%), “good” by 3 (8%), and “fair” by 1 (3%) respondents (mean score 4.44/5). Most of the respondents felt that the podcast provided access to content experts they otherwise wouldn't have access to (mean score 4.28/5), improved their critical appraisal skills (mean score 4.42/5), helped them stay updated on the latest data in hematologic malignancies (mean score 4.56/5), and improved their knowledge in clinically relevant areas (mean score 4.47/5). The three most common additional episode formats that respondents expressed interest in were pro-con debate (77%), evidence-based medicine (69%), and roundtable discussions (57%). Conclusion: In summary, “ Blood Cancer Talks” has distinguished itself as a pioneering medical podcast with a broad, global listenership. Its specialized focus on hematologic malignancies resonates with an engaged audience of clinicians. An encouraging 94% of respondents either agree or strongly agree that this resource has been instrumental in keeping them informed about the latest research and advancements in hematologic malignancies. We hope to continue to develop clinically relevant, expert-focused episodes across the breadth of hematologic malignancies, including new episode formats that incorporate listener feedback.

Early Mobilization for Critically Ill Patients.

Advances in the field of critical care medicine have helped improve the survival rate of these ill patients. Several studies have demonstrated the potential benefits of early mobilization as an important component of critical care rehabilitation. However, there have been some inconsistent results. Moreover, the lack of standardized mobilization protocols and the associated safety concerns are a barrier to the implementation of early mobilization in critically ill patients. Therefore, determining the appropriate modalities of implementation of early mobilization is a key imperative to leverage its potential in these patients. In this paper, we review the contemporary literature to summarize the strategies for early mobilization of critically ill patients, assess the implementation and validity based on the International Classification of Functioning, Disability and Health, as well as discuss the safety aspects of early mobilization.

Impactful publications of critical care medicine research in China: A bibliometric analysis.

Although publications have been increasing rapidly, the research quality has yet to improve in the field of critical care medicine (CCM) in China. This study aimed at investigating the current status of and the influential factors for impactful publications in CCM research by Chinese authors. Publications by authors with the affiliation of critical care medicine department or intensive care unit (CCM/ICU) in Chinese as well as American hospitals from 2001 to 2020 were retrieved from the Web of Science Core Collection (WoSCC) database for this bibliometric analysis. Moreover, statistical analyses to test factors affecting impactful publications by Chinese authors were performed. Of 13,487 articles retrieved by this search strategy, 6,622 were published by Chinese authors as first or corresponding authors. The annual publications by Chinese authors have been rapidly increasing from 2001 to 2020, and so did the citations to these articles. However, the proportion in the world of publications by Chinese authors was much less than that by American authors each year [M (IQR): 1.85 (9.592) vs. 27.77 (7.3), p < 0.001]. In addition, impactful articles were significantly less published by Chinese than by American authors, including articles either in journals with a high impact factor (p < 0.001) or in the top 10 journals in the field of CCM (5.4 vs 13.4%, p < 0.001), and articles with high citation frequency as well (p < 0.001). Moreover, the percentage of impactful publications by Chinese authors was likely associated with academic background and regions of the author's affiliations, funds support, public health events of COVID-19, and collaboration between authors. Our results demonstrated that CCM research in China grew rapidly in the recent 20 years. However, the impactful publications remained limited, largely owing to the shortage of comprehensive research training, inactive collaboration, and underfunded CCM research.

Current situation and reflection of clinical trials in the field of burn medicine in China

Clinical trials are of great significance in formulating guidelines or consensus for the diagnosis and treatment of burns. However, the innate advantages of clinical trials in the field of burn medicine in China have not been translated into evidence-based medical data. Our research group counted the literature published in major academic journals in the field of burn medicine at home and abroad from 2010 to 2020 in Chinese and English databases, and found that the number and proportion of clinical trials in the field of burn medicine published in Chinese journals were generally lower than those in English journals. Moreover, the number and proportion of clinical trials in the field of burn medicine published in Chinese journals were lower than those in the field of critical care medicine. On this basis, our research group statistically analyzed the registration status of clinical trials in the field of burn medicine from 2010 to 2020, and found that the registration volume and completion volume of clinical trials in the field of burn medicine in China were not only lower than those in the field of burn medicine in the United States, but also lower than those in the field of critical care medicine in China. The reasons for insufficient clinical trials in the field of burn medicine may be the decrease in the incidence of burns, the decrease in the number of burn specialists and their low income, and the lack of burn research talents. It is necessary for China to integrate the advantages of clinical resources in the field of burn medicine, strengthen clinical trial research, and improve the discourse power in the international community.

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).

A CASE OF DEXMEDETOMIDINE-INDUCED DRUG FEVER: AN IMPORTANT AND PRESS-EDEX-ING ISSUE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Dexmedetomidine has revolutionized the field of critical care medicine, providing clinicians a short-acting, well-tolerated sedative. Cardiovascular adverse effects are well described with this agent (1). Less common adverse effects such as fever are increasingly being reported (2). Previous studies demonstrated no appreciable rate of dexmedetomidine-related fever (1, 3). Here we report a case of high-grade fever in the intensive care unit (ICU) after initiation of dexmedetomidine, with resolution after discontinuation. CASE PRESENTATION: A 34-year-old male with a past medical history of alcohol abuse and asthma was admitted to the general ward with Coronavirus disease 2019 (COVID-19) pneumonia. His course was complicated by severe hypoxia and subsequent pulseless electrical activity (PEA) arrest, requiring ICU transfer after achieving return of circulation and undergoing mechanical ventilation. On hospital day 7, after improvement in respiratory status with COVID-19 management including corticosteroids, as well as treatment with ceftriaxone and azithromycin given concern for superimposed bacterial pneumonia, he was transitioned to dexmedetomidine in preparation for a ventilator weaning trial. He developed fevers over the following 12 hours, initially to 39.4 C (102.9 F) prompting empiric sepsis management with intravenous fluids and broad-spectrum antibiotics (see figure-1). Despite this, he continued to have fevers to a maximum core temperature of 41.1 C (106 F). Blood, fungal, and respiratory cultures were unremarkable. With no clear infectious source or alternative explanation for severe hyperthermia, the decision was made to wean off dexmedetomidine given suspicion for drug-induced fever, upon which core temperature returned to 37.8 C (100.1 F). He remained afebrile, and eventually extubated and discharged in stable condition. DISCUSSION: We present a case of severe hyperthermia corresponding to, with a probable association using the Naranjo Adverse Drug Reaction Probability Scale, dexmedetomidine initiation, followed by resolution of fever after discontinuation. Antimicrobial therapy had no observable effect on the fever, and extensive infectious work-up was unremarkable. Completely attributing a febrile episode in the ICU setting to a medication is a difficult task. Furthermore, adequately powering studies to identify rare medication adverse effects in the ICU is a challenge, which may explain the absence of fever as a documented adverse effect of dexmedetomidine (1,2,4). In this case, no alternate diagnoses were evident, thus management was focused on discontinuing the presumed inciting agent. CONCLUSIONS: Recognizing dexmedetomidine as an etiology of severe hyperthermia in the ICU may help mitigate excessive therapies and improve outcomes. Further research is warranted to describe risk factors and proper recognition for when fevers occur with dexmedetomidine. REFERENCE #1: Hospira (2014) Precedex® (dexmedetomidine hydrochloride) [package insert]. Lake Forest, IL: Hospira, Inc. REFERENCE #2: Peterson J, Thomas W, Michaud C, et al. Incidence of Fever Associated With Dexmedetomidine in the Adult Intensive Care Unit. J Pharm Pract. 2021 Apr 5:8971900211004828. REFERENCE #3: Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine for Long-Term Sedation Investigators. JAMA. 2012 Mar 21;307(11):1151-60. DISCLOSURES: No relevant relationships by Raef Fadel, source=Web Response No relevant relationships by Sara Hegab, source=Web Response No relevant relationships by Michael Reaume, source=Web Response No relevant relationships by Zachary Smith, source=Web Response

Research progress of vitamin metabolomics in acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a clinical syndrome with high morbidity and mortality in the field of critical care medicine. Exploring the biological markers (groups) for early warning, severity and prognosis assessment of ARDS is the critical points of recent research. Metabolic disorders and metabolic support are drawing more and more attention in the treatment of critically ill patients. Lots of studies have shown that the changes of vitamins and their metabolites can dynamically correspond to the damage of ARDS, which might be the biomarker for early diagnosis, dynamic evaluation, and specific treatment of ARDS. Vitamin metabolomics, as an important branch of metabolomics, can better help us find the potential biomarkers for ARDS. Metabolomics is the latest technology of precision medicine. The use of metabolomics to analyze vitamin metabolites and their pathways is of great significance in the diagnosis, treatment and monitoring of critical illnesses. This article reviews the research progress of vitamin metabolomics in ARDS.

John W. Severinghaus, M.D., 1922 to 2021.

John W. Severinghaus, M.D., 1922 to 2021.

INVESTIGATION OF THE GLOBAL OUTCOMES OF ACUTE RESPIRATORY DISTRESS SYNDROME WITH THE EFFECT OF COVID-19 IN PUBLICATIONS: A BIBLIOMETRIC ANALYSIS BETWEEN 1980 AND 2020

Objective: Acute respiratory distress syndrome (ARDS) is regarded as a serious complication with high mortality rates and constitutes an important health problem during the COVID-19 pandemic. Therefore, a thorough bibliometric study on ARDS is needed. In this study, it was aimed to holistically summarize the articles published on ARDS between the years 1980 and 2020 using statistical methods and bibliometric analyses.Material and Methods: The literature was scanned using the Web of Science (WoS) database. Keywords used on WoS included “acute respiratory distress syndrome”, “adult respiratory distress syndrome” and “ARDS”. The search was carried out on the “titles” of the publications, and the articles obtained were bibliometrically analyzed. Linear and non-linear regression analysis was used in order to estimate the number of future studies.Results: A total of 11.934 publications were found. Of these publications, 5402 were articles (45.3%) on which the bibliometric analysis was performed. A high increase trend was observed in the number of publications during COVID-19. Most articles were published in the field of Critical Care Medicine (1965, 36.4%). The top four countries contributing to the literature were the USA (1967, 36.4%), Germany (534, 9.9%), France (534, 9.9%), and China (534, 9.9%). The most active 4 institutions were confirmed as theUniversity of Toronto (154), University of California San Francisco (153), University of Washington (153) and University of Harvard (151). The first 2 journals with the most publications were Critical Care Medicine (394) and Intensive Care Medicine (248).Conclusion: In this comprehensive bibliometric study on ARDS on which the number of research increases day by day with the effect of the COVID-19 pandemic, a summarized information of 5402 articles published between 1980 and 2020 was reported. This study will be a guide for scientists and clinicians regarding the global output of ARDS.

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).

Bibliometric Analysis of The Last 40 Years of Chest Journal

Chest Journal, which began to be scanned in the Web of Science in 1980, is one of the leading journals in the field of Critical Care Medicine and Respiratory System (quartile 1). In this study, the research trends of the publications in the Chest Journal were examined using three different bibliometric analysis programs (Bibliometrix, VOSviewer, and CiteSpace) in the period between 1980-2019. Along with the main statistics, keyword co-occurrence network map, density document co-citation, time map, and burst (references) analysis were performed. According to the results of the analysis, the research trends of Chest Journal were subject to discussion. The countries with the most publications are America, Canada, the United Kingdom, France, and Japan. According to the Co-Occurrence network map analysis, Chest journal's publications consist of clusters of cellular structures, thoracic oncology, chest infection, pulmonary and cardiovascular, sleep and pulmonary function test, and obstructive lung diseases. The studies in the "COPD / Formoterol Metered Dose inhaler" and "Patients / VTE disease chest guideline" clusters were found to be the most recent studies. This article has the potential to provide a valuable reference for scientists to understand Chest Journal's research trends and to grasp current issues in the field.