Delirium is one of the most common yet most elusive syndromes in the ICU, marked by fluctuating disturbances in awareness and attention arising from complex, multifactorial pathophysiological processes. Despite decades of research and the identification of numerous risk factors, delirium continues to evade full understanding and remains a major therapeutic challenge. Its consequences are profound: higher morbidity and mortality, prolonged ICU and hospital length of stay, and a substantial economic burden of thousands of dollars in excess costs. Beyond being a clinical complication, delirium has become a silent disruptor of modern critical care. This raises an urgent and challenging question: rather than endlessly treating the aftermath of delirium, could the key breakthrough lie in reimagining the ICU itself? Transformative investments in architecture, infrastructure, and human-centered design—together with elevating nonpharmacological strategies alongside pharmacological therapies—may hold the potential to prevent delirium at its roots. In this narrative review, we synthesize current knowledge on the epidemiology, etiology, pathophysiology, diagnosis, prevention, and management of ICU delirium. We highlight how innovative ICU redesign, holistic care approaches, and integrated evidence-based strategies may reshape the fight against delirium, turning the ICU into not just a site of survival but a therapeutic tool in its own right.

Background: Optimal energy and protein delivery during the early phase of severe trauma remains unclear. Observational studies frequently contradict the findings of randomized controlled trials, raising concerns about confounding factors. The aim of this study is to assess nutritional adequacy and daily variability in the energy gaps and its impact on outcomes using innovative statistical methods. Methods: Prospective observational study enrolled severely injured patients in the ICU at the Level 1 trauma center between October 2023 to April 2025. To describe the evolution of calorie and protein deficits during the first 10-day ICU stay, we utilized a linear mixed-effects model to estimate each patient’s individual energy gap trajectory. Results: 286 patients were analyzed. Median APACHE II and ISS score was 16.0 (12.0–20.0) and 22.0 (18.0–27.0), respectively. Mortality rate was 35.3%. Patients received 68.3% of prescribed calories and 76.8% of proteins. Admission energy deficit, rate of caloric intake, and their interaction are associated with ICU mortality. Increased day-to-day energy variability was associated with longer duration of mechanical ventilation (HR = 0.55, 95% CI: 0.31–0.99; p = 0.047). Patients who achieved better caloric (HR = 0.68, 95% CI: 0.48–0.98, p = 0.036) and protein (HR = 0.29, 95% CI: 0.09–0.96, p = 0.043) nutrition had a lower hazard of developing nosocomial infection. Conclusions: This study supports the 2023 ESPEN guidelines, showing that achieving the recommended energy and protein intake during the early phase of severe trauma is linked to lower mortality rates, shorter mechanical ventilation time, and reduced risk of nosocomial infections.

The present multicentre, prospective cohort study of intensive care unit (ICU) patients aims to validate the recently developed Gastrointestinal Dysfunctio

Background: Behçet’s disease (BD) and granulomatosis with polyangiitis (GPA) are distinct vasculitides. PR3-ANCA is considered specific for GPA, yet rare BD cases demonstrate positivity, creating diagnostic dilemmas. Case Presentation: We describe a young man fulfilling criteria for BD, presenting with recurrent oral and genital ulcers, ocular inflammation, catastrophic jejunal perforations, pulmonary embolism, and myocardial infarction with non-obstructive coronary arteries. Despite strong PR3-ANCA positivity, the global phenotype was consistent with BD. Management required a complex, multimodal immunosuppressive regimen that included corticosteroids, cyclophosphamide, therapeutic plasma exchange, and rituximab. Conclusions: PR3-ANCA positivity may represent a severe BD phenotype rather than true GPA overlap, underscoring the need for individualized treatment strategies.

The trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmias including hemodynamic irregularities, apnea, and gastric hypermotility during stimulation of sensory branches of the trigeminal nerve. Back in 1999 when TCR was first described as such, a clinical discussion on the establishment of terminology is ongoing. We present a case of a 31-year-old male patient who was admitted to the Emergency Department due to traumatic brain injury who died with clinical manifestations of TCR. TCR can be a red flag for neurosurgeons when treating patients with traumatic brain injury.

Introduction: Trauma represents one of the most significant problems in public healthcare worldwide. It is one of the leading causes of mortality, particularly among children and young adults, but with a significant majority of non-fatal injuries that result in lifelong disabilities and health consequences. Proper and timely identification of patients with a higher risk of mortality is crucial for better outcomes in patients who suffer from trauma. The aim of this study is to identify potential predictors of in-hospital mortality among patients who suffered trauma and are treated in the ICU (Intensive Care Unit). Methods: The retrospective cohort study was conducted in a trauma, 12-bed ICU at the University Emergency Centre, University Clinical Centre of Serbia, Belgrade. All consecutive patients with blunt trauma were admitted to the ICU between August 2021 and August 2022. The primary outcomes of interest were all-cause in-hospital mortality. A value of p < 0.05 was considered statistically significant. Results: GCS (Hazard ratio 0.924 95%CI 0.873-0.979), vasopressors (Hazard ratio 3.47 95%CI 1.373-8.787) and age (Hazard ratio 1.030 95%CI 1.014-1.047) can independently predict in-hospital mortality. Conclusion:This study suggests risk factors for unfavorable clinical outcomes after severe trauma. It may be essential to properly and promptly differentiate between individuals with lower prognoses, which can lead to prompt and more aggressive treatment of these patients and might decrease in-hospital mortality. Age, vasopressors and mechanical ventilation, in particular, may be helpful indicators of in-hospital mortality of traumatized patients treated in the ICU.