• Anthony C Gordon, Narges Alipanah-Lechner, Lieuwe D Bos, Jose Dianti, Janet V Diaz, Simon Finfer, Tomoko Fujii, Evangelos J Giamarellos-Bourboulis, Ewan C Goligher, GongMichelle NgMNDivision of Critical Care Medicine and.Division of Pulmonary Medicine, Department of Medicine and Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York., Eleni Karakike, Vincent X Liu, Nuttha Lumlertgul, John C Marshall, David K Menon, Nuala J Meyer, Elizabeth S Munroe, Sheila N Myatra, Marlies Ostermann, Hallie C Prescott, Adrienne G Randolph, Edward J Schenck, Christopher W Seymour, Manu Shankar-Hari, Mervyn Singer, Marry R Smit, Aiko Tanaka, Fabio S Taccone, B Taylor Thompson, Lisa K Torres, Tom van der Poll, Jean-Louis Vincent, and Carolyn S Calfee.
• Division of Anaesthetics, Pain Medicine and Intensive Care and.
• Am. J. Respir. Crit. Care Med. 2024 Jul 15; 210 (2): 155166155-166.

AbstractCritical care uses syndromic definitions to describe patient groups for clinical practice and research. There is growing recognition that a "precision medicine" approach is required and that integrated biologic and physiologic data identify reproducible subpopulations that may respond differently to treatment. This article reviews the current state of the field and considers how to successfully transition to a precision medicine approach. To impact clinical care, identification of subpopulations must do more than differentiate prognosis. It must differentiate response to treatment, ideally by defining subgroups with distinct functional or pathobiological mechanisms (endotypes). There are now multiple examples of reproducible subpopulations of sepsis, acute respiratory distress syndrome, and acute kidney or brain injury described using clinical, physiological, and/or biological data. Many of these subpopulations have demonstrated the potential to define differential treatment response, largely in retrospective studies, and that the same treatment-responsive subpopulations may cross multiple clinical syndromes (treatable traits). To bring about a change in clinical practice, a precision medicine approach must be evaluated in prospective clinical studies requiring novel adaptive trial designs. Several such studies are underway, but there are multiple challenges to be tackled. Such subpopulations must be readily identifiable and be applicable to all critically ill populations around the world. Subdividing clinical syndromes into subpopulations will require large patient numbers. Global collaboration of investigators, clinicians, industry, and patients over many years will therefore be required to transition to a precision medicine approach and ultimately realize treatment advances seen in other medical fields.

20 keywords...

hide…