Redefining critical illness.

Abstract

Research and practice in critical care medicine have long been defined by syndromes, which, despite being clinically recognizable entities, are, in fact, loose amalgams of heterogeneous states that may respond differently to therapy. Mounting translational evidence-supported by research on respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-suggests that the current syndrome-based framework of critical illness should be reconsidered. Here we discuss recent findings from basic science and clinical research in critical care and explore how these might inform a new conceptual model of critical illness. De-emphasizing syndromes, we focus on the underlying biological changes that underpin critical illness states and that may be amenable to treatment. We hypothesize that such an approach will accelerate critical care research, leading to a richer understanding of the pathobiology of critical illness and of the key determinants of patient outcomes. This, in turn, will support the design of more effective clinical trials and inform a more precise and more effective practice at the bedside.

• Authors: David M Maslove, Benjamin Tang, Manu Shankar-Hari, Patrick R Lawler, Derek C Angus, J Kenneth Baillie, Rebecca M Baron, Michael Bauer, Timothy G Buchman, Carolyn S Calfee, Claudia C Dos Santos, Evangelos J Giamarellos-Bourboulis, Anthony C Gordon, John A Kellum, Julian C Knight, Aleksandra Leligdowicz, Daniel F McAuley, Anthony S McLean, David K Menon, Nuala J Meyer, Lyle L Moldawer, Kiran Reddy, John P Reilly, James A Russell, Jonathan E Sevransky, Christopher W Seymour, Nathan I Shapiro, Mervyn Singer, Charlotte Summers, Timothy E Sweeney, B Taylor Thompson, Tom van der Poll, Balasubramanian Venkatesh, Keith R Walley, Timothy S Walsh, Lorraine B Ware, Hector R Wong, Zsolt E Zador, John C Marshall
• Journal: Nature medicine (Nat Med) Vol. 28 Issue 6 Pg. 1141-1148 (06 2022) ISSN: 1546-170X [Electronic] United States
• PMID: 35715504 (Publication Type: Journal Article, Review)
• Copyright: © 2022. Springer Nature America, Inc.

Topics

• COVID-19
• Critical Care
• Critical Illness
• Humans
• SARS-CoV-2
• Syndrome