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Background and Objectives: Maxillofacial trauma represents a significant global health challenge with substantial physical, psychological, and socioeconomic consequences. Materials and Methods: This narrative review analyzed 112 articles published between 2000 and 2024 examining epidemiology, prevention, economics, and outcomes of maxillofacial trauma in critical care settings. Results: Road traffic accidents remain the primary cause globally, followed by interpersonal violence and occupational injuries. Effective prevention strategies include seat belt laws, helmet legislation, and violence prevention programs. Economic burden encompasses direct healthcare costs (averaging USD 55,385 per hospitalization), productivity losses (11.8 workdays lost per incident), and rehabilitation expenses (USD 3800–18,000 per patient). Surgical management has evolved toward early intervention, minimally invasive approaches, and advanced techniques using computer-aided design and 3D printing. Complications affect 3–33% of patients, with significant functional disabilities and psychological sequelae (post-traumatic stress disorder in 27%, depression/anxiety in 20–40%). Conclusion: Maxillofacial trauma management requires multidisciplinary approaches addressing both immediate treatment and long-term rehabilitation. Despite technological advances, disparities in specialized care access persist globally. Future efforts should implement evidence-based prevention strategies, reduce care disparities, and develop comprehensive approaches addressing physical, psychological, and socioeconomic dimensions through collaboration among healthcare professionals, policymakers, and community stakeholders.

Hypophosphatemia, defined as serum phosphate levels below 2.5 mg/dL, is a common yet underrecognized electrolyte disturbance in critically ill patients, with prevalence estimates reaching up to 80%. This review explores the intricate bidirectional relationship between hypophosphatemia and hyperventilation, emphasizing its profound implications for respiratory function and critical care management. Hypophosphatemia impairs oxygen delivery by depleting 2,3-diphosphoglycerate (2,3-DPG), disrupts central respiratory drive, and weakens respiratory muscles, leading to hyperventilation, ventilatory failure, and prolonged mechanical ventilation. Conversely, hyperventilation exacerbates hypophosphatemia through respiratory alkalosis, triggering intracellular phosphate shifts and metabolic cascades that rapidly deplete serum levels. This cycle creates significant challenges for ventilator weaning and increases morbidity and mortality. Underlying mechanisms include impaired ATP synthesis, altered chemoreceptor sensitivity, and systemic inflammatory responses. Hypophosphatemia-induced hyperventilation manifests as unexplained tachypnea and respiratory alkalosis, often misdiagnosed as anxiety or pain, while hyperventilation-induced hypophosphatemia contributes to diaphragmatic dysfunction and poor ventilatory performance. Common precipitating factors include refeeding syndrome, diabetic ketoacidosis, continuous renal replacement therapy, and malnutrition. Complications extend beyond respiratory dysfunction to include cardiac depression, immune dysfunction, prolonged ICU stays, and increased healthcare costs. Current diagnostic approaches rely on serum phosphate measurements, which poorly reflect total body stores due to significant intracellular shifts. Emerging biomarkers such as fibroblast growth factor 23 (FGF23) and advanced monitoring technologies, including continuous phosphate tracking, may enhance recognition. Treatment strategies emphasize targeted phosphate repletion based on severity, with intravenous supplementation and ventilatory support tailored to minimize complications. Preventive measures, including risk stratification, prophylactic supplementation, and ventilator management, are critical for high-risk populations. Despite advances, knowledge gaps persist in optimizing monitoring and repletion protocols, understanding genetic variations, and identifying ideal phosphate targets for improved respiratory outcomes. This review provides a comprehensive framework for recognizing and managing hypophosphatemia’s impact on respiratory dysfunction in critically ill patients. Adopting evidence-based interventions and leveraging emerging technologies can significantly improve clinical outcomes, reduce ICU complications, and enhance recovery in this vulnerable population.

Obstructive sleep apnea (OSA) is increasingly recognized as a chronic condition that is closely interrelated to olfactory disorders, with a significant contribution to quality of health and overall quality of life. This narrative review aims to provide a thorough overview of the emerging evidence that now integrates these two previously considered distinct physiologic systems. Studies published recently have reported a significantly higher frequency of olfactory dysfunction among OSA patients compared to the general population, which raises the possibility of a causal relationship. We explore the postulated mechanisms behind this association, namely, the chronic intermittent hypoxia, local inflammatory effect, and neuroanatomical changes attributed to OSA. The review further explores the clinical impacts of this relationship through proposing the potential for an olfactory assessment to be used as a diagnostic modality for OSA and the effects of OSA treatment on olfactory function. Thus, we explore the difficulties in treating patients who experience both and suggest future areas for research. This review attempts to bridge the gap between the existing literature and impending investigation necessary for a better management of the interaction of sleep apnea and the human sense of smell.

Background: Airway management in patients with obstructive sleep apnea (OSA) presents unique challenges for anesthesiologists and other airway practitioners. This comprehensive review examines current evidence and clinical practices for managing difficult airways in this high-risk population. OSA is characterized by specific anatomical and physiological alterations that increase both the likelihood of encountering difficult intubation and the risk of rapid desaturation during airway manipulation. Methods: Preoperative assessment of OSA patients requires integration of traditional difficult airway evaluation with OSA-specific considerations, including severity indices, oxygen desaturation patterns, and continuous positive airway pressure dependency. Conventional direct laryngoscopy often proves inadequate in these patients, prompting the development and refinement of alternative approaches. Videolaryngoscopy has emerged as a particularly valuable technique in OSA patients, offering improved glottic visualization while maintaining physiologic positioning. Flexible endoscopic techniques, particularly awake flexible bronchoscopic intubation, remain essential for high-risk scenarios, though they require considerable expertise. Results: Recent technological innovations have produced hybrid devices combining multiple modalities to address the specific challenges presented by OSA patients. Adjunctive tools and techniques, including specialized introducers, exchange catheters, and high-flow nasal oxygen, play critical roles in extending safe apnea time and facilitating successful intubation. Professional society guidelines now incorporate OSA-specific recommendations, emphasizing thorough preparation, appropriate device selection, and comprehensive monitoring. Conclusions: Effective management ultimately requires not only appropriate technology but also systematic preparation, strategic device selection, and meticulous execution. As OSA prevalence continues to rise globally, optimizing airway management approaches for this challenging population remains a critical priority for patient safety.

Duplex-Doppler ultrasonography has become an essential tool in the diagnosis and management of kidney diseases, allowing clinicians to assess renal hemodynamics, detect vascular abnormalities, and monitor disease progression. Among the various Doppler-derived parameters, the renal resistive index (RRI) has gained particular attention both as a diagnostic tool and a prognostic marker in nephrology. Traditionally considered an indicator of parenchymal perfusion, recent evidence highlights its strong association with systemic hemodynamic factors, particularly arterial stiffness, positioning RRI as a valuable tool for evaluating patients with systemic vascular impairment, such as hypertension, diabetes mellitus, and atherosclerosis. RRI has been strongly linked to vascular damage, which in turn is influenced by inflammation and endothelial dysfunction, making it a reliable marker of cardiovascular damage and a potential predictor of cardiovascular risk. Furthermore, emerging studies suggest that RRI could serve as a dynamic parameter to monitor vascular changes induced by therapeutic interventions. This narrative review summarizes the classic and evolving applications of RRI, from its origin as a renal hemodynamic marker to its emerging role as a systemic vascular biomarker with diagnostic and prognostic significance in cardiovascular and metabolic diseases.

Assessment of fluid-responsiveness is a key aspect of daily management in critically ill patients. Non-invasive evaluation of the variation of inferior vena cava (IVC) diameter during ventilation may provide useful information. However, a standard sagittal IVC visualization from the subcostal (SC) region is not always feasible. An alternative method to visualize the IVC is a coronal trans-hepatic (TH) approach. We performed a systematic search to explore the interchangeability of IVC evaluation with SC and TH views. We searched Medline and EMBASE to identify prospective studies. We did not consider the relationship between axial and sagittal visualization of the IVC. We included seven studies reporting data on IVC evaluation with both SC and TH IVC views. Four studies were conducted on spontaneously breathing patients/volunteers, two on fully mechanically ventilated patients, and one in a mixed population, with large heterogeneity regarding the analyses reported. Limits of agreement between SC and TH were large. Concordance of the IVC collapsibility/distensibility indices are not interchangeable between SC and TH view. Correlation between diameters measured with SC and TH approach and intra/inter-observer correlation produced variable results. An overview of the included studies suggests that longitudinal TH and SC assessment of IVC size and respiratory variation are not interchangeable. New studies with accurate data reporting and appropriate statistical analysis are needed to define proper cut-offs for fluid responsiveness when using TH approach for IVC visualization. •Assessing fluid-responsiveness is pivotal in management of critical care patients•Inferior vena cava (IVC) diameters' change during breathing may provide useful info•Sagittal IVC visualization from the subcostal (SC) region is not always feasible•An alternative for IVC visualization is the coronal trans-hepatic (TH) approach•Based on our systematic review, longitudinal SC and TH views do not yield similar results

A dysregulated host response to infection causes organ dysfunction in sepsis and septic shock, two potentially fatal diseases. They continue to be major worldwide health burdens with high rates of morbidity and mortality despite advancements in medical care. The goal of this thorough review was to present a thorough summary of the current body of knowledge about the prevalence of sepsis and septic shock worldwide. Using widely used computerized databases, a comprehensive search of the literature was carried out, and relevant studies were chosen in accordance with predetermined inclusion and exclusion criteria. A narrative technique was used to synthesize the data that were retrieved. The review’s conclusions show how widely different locations and nations differ in terms of sepsis and septic shock’s incidence, prevalence, and fatality rates. Compared to high-income countries (HICs), low- and middle-income countries (LMICs) are disproportionately burdened more heavily. We talk about risk factors, comorbidities, and difficulties in clinical management and diagnosis in a range of healthcare settings. The review highlights the need for more research, enhanced awareness, and context-specific interventions in order to successfully address the global burden of sepsis and septic shock.

Background: Intraoperative hypotension is associated with increased postoperative morbidity and mortality. Methods: We randomly assigned patients undergoing major general surgery to early warning system (EWS) and hemodynamic algorithm (intervention group, n = 20) or standard care (n = 20). The primary outcome was the difference in hypotension (defined as mean arterial pressure < 65 mmHg) and as secondary outcome surrogate markers of organ injury and oxidative stress. Results: The median number of hypotensive episodes was lower in the intervention group (−5.0 (95% CI: −9.0, −0.5); p < 0.001), with lower time spent in hypotension (−12.8 min (95% CI: −38.0, −2.3 min); p = 0.048), correspondent to −4.8% of total surgery time (95% CI: −12.7, 0.01%; p = 0.048).The median time-weighted average of hypotension was 0.12 mmHg (0.35) in the intervention group and 0.37 mmHg (1.11) in the control group, with a median difference of −0.25 mmHg (95% CI: −0.85, −0.01; p = 0.025). Neutrophil Gelatinase-Associated Lipocalin (NGAL) correlated with time-weighted average of hypotension (R = 0.32; p = 0.038) and S100B with number of hypotensive episodes, absolute time of hypotension, relative time of hypotension and time-weighted average of hypotension (p < 0.001 for all). The intervention group showed lower Neuronal Specific Enolase (NSE) and higher reduced glutathione when compared to the control group. Conclusions: The use of an EWS coupled with a hemodynamic algorithm resulted in reduced intraoperative hypotension, reduced NSE and oxidative stress.

[...]the decision to intubate may sometimes imply the need for a long inter-hospital transfer. Under certain emergency circumstances, even military healthcare teams have been deployed to assist the ambulance service [4]. [...]it frequently happens that intubated patients remain in the Emergency Department (ED) for several hours before the transfer can be accomplished. [...]even if an ICU bed has been found and a specialized ambulance is available, the risks associated with long inter-hospital transfers of COVID-19 patients should not be underestimated [5].