Redefining critical illness

被引：212

作者：

Maslove, David M. ^{[1
,2
]}

Tang, Benjamin ^{[3
]}

Shankar-Hari, Manu ^{[4
,5
]}

Lawler, Patrick R. ^{[6
,7
]}

Angus, Derek C. ^{[8
,9
]}

Baillie, J. Kenneth ^{[5
,10
,11
]}

Baron, Rebecca M. ^{[12
,13
]}

Bauer, Michael ^{[14
,15
]}

Buchman, Timothy G. ^{[16
,17
]}

Calfee, Carolyn S. ^{[18
]}

dos Santos, Claudia C. ^{[7
,19
]}

Giamarellos-Bourboulis, Evangelos J. ^{[20
]}

Gordon, Anthony C. ^{[21
]}

Kellum, John A. ^{[8
]}

Knight, Julian C. ^{[22
]}

Leligdowicz, Aleksandra ^{[23
,24
]}

McAuley, Daniel F. ^{[25
,26
]}

McLean, Anthony S. ^{[3
]}

Menon, David K. ^{[27
]}

Meyer, Nuala J. ^{[28
]}

Moldawer, Lyle L. ^{[29
]}

Reddy, Kiran ^{[25
,26
]}

Reilly, John P. ^{[28
]}

Russell, James A. ^{[30
]}

Sevransky, Jonathan E. ^{[16
,31
]}

Seymour, Christopher W. ^{[8
]}

Shapiro, Nathan I. ^{[13
,32
]}

Singer, Mervyn ^{[33
]}

Summers, Charlotte ^{[34
]}

Sweeney, Timothy E. ^{[35
]}

Thompson, B. Taylor ^{[13
,36
]}

van der Poll, Tom ^{[37
]}

Venkatesh, Balasubramanian ^{[38
,39
]}

Walley, Keith R. ^{[30
]}

Walsh, Timothy S. ^{[40
]}

Ware, Lorraine B. ^{[41
,42
,43
,44
]}

Wong, Hector R. ^{[45
]}

Zador, Zsolt E. ^{[46
]}

Marshall, John C. ^{[7
,46
,47
,48
]}

机构：

[1] Queens Univ, Dept Crit Care Med, Kingston, ON, Canada

[2] Kingston Hlth Sci Ctr, Kingston, ON, Canada

[3] Nepean Hosp, Dept Intens Care Med, Sydney, NSW, Australia

[4] Queens Med Res Inst, Inst Regeneration & Repair, Ctr Inflammat Res, Edinburgh, Midlothian, Scotland

[5] Royal Infirm Edinburgh NHS Trust, Intensive Care Med, NHS Lothian, Edinburgh, Midlothian, Scotland

[6] Univ Hlth Network, Peter Munk Cardiac Ctr, Cardiac Intens Care Unit, Toronto, ON, Canada

[7] Univ Toronto, Interdepart Div Crit Care Med, Toronto, ON, Canada

[8] Univ Pittsburgh, Dept Crit Care Med, Pittsburgh, PA USA

[9] Univ Pittsburgh Med Ctr, Pittsburgh, PA USA

[10] Univ Edinburgh, Roslin Inst, Edinburgh, Midlothian, Scotland

[11] Univ Edinburgh, Ctr Inflammat Res, Pandem Sci Hub, Edinburgh, Midlothian, Scotland

[12] Brigham & Womens Hosp, Div Pulm & Crit Care Med, Boston, MA USA

[13] Harvard Med Sch, Boston, MA USA

[14] Jena Univ Hosp, Dept Anesthesiol & Intens Care Med, Jena, Germany

[15] Jena Univ Hosp, Ctr Sepsis Care & Control, Jena, Germany

[16] Emory Univ, Emory Crit Care Ctr, Atlanta, GA USA

[17] Santa Fe Inst, Santa Fe, NM USA

[18] Univ Calif San Francisco, Dept Med, Div Pulm Crit Care Allergy & Sleep Med, San Francisco, CA USA

[19] Unity Hlth Toronto, Keenan Ctr Biomed Res St Michaels Hosp, Toronto, ON, Canada

[20] Natl & Kapodistrian Univ Athens, Med Sch, Dept Internal Med 4, Athens, Greece

[21] Imperial Coll London, Div Anaesthet Pain Med & Intensive Care, London, England

[22] Univ Oxford, Wellcome Ctr Human Genet, Oxford, England

[23] Univ Western Ontario, Dept Med, Div Crit Care, London, ON, Canada

[24] Univ Western Ontario, Dept MicroBiol & Immunol, London, ON, Canada

[25] Royal Victoria Hosp, Reg Intens Care Unit, Belfast, North Ireland

[26] Queens Univ Belfast, Wellcome Wolfson Inst Expt Med, Belfast, Antrim, North Ireland

[27] Univ Cambridge, Dept Med, Div Anaesthesia, Cambridge, England

[28] Univ Penn, Dept Med Pulm Allergy & Crit Care Div, Philadelphia, PA USA

[29] Univ Florida, Sepsis & Crit Illness Res Ctr, Dept Surg, Coll Med, Gainesville, FL USA

[30] Univ British Columbia, Ctr Heart Lung Innovat & Crit Care Med, Vancouver, BC, Canada

[31] Emory Univ, Sch Med, Div Pulm Allergy Crit Care & Sleep, Atlanta, GA USA

[32] Beth Israel Deaconess Med Ctr, Dept Emergency Med, Boston, MA USA

[33] UCL, Bloomsbury Inst Intens Care Med, Div Med, London, England

[34] Univ Cambridge, Dept Med, Sch Med, Cambridge, England

[35] Inflammatix Inc, Burlingame, CA USA

[36] Massachusetts Gen Hosp, Divis BioStat & Pulm, Crit Care Med, Boston, MA USA

[37] Univ Amsterdam, Amsterdam UMC, Amsterdam, Netherlands

[38] Wesley & Princess Alexandra Hosp, Dept Intens Care, Brisbane, Qld, Australia

[39] Univ New South Wales, George Inst Global Hlth, Sydney, NSW, Australia

[40] Univ Edinburgh, Deanery Mol Genet & Populat Hlth Sci, Usher Inst Populat Hlth Sci, Edinburgh, Midlothian, Scotland

[41] Vanderbilt Univ, Sch Med, Dept Med, Nashville, TN USA

[42] Vanderbilt Univ, Sch Med, Dept Pathol, Nashville, TN USA

[43] Vanderbilt Univ, Sch Med, Dept Microbiol, Nashville, TN USA

[44] Vanderbilt Univ, Sch Med, Dept Immunol, Nashville, TN USA

[45] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Cincinnati, OH USA

[46] Univ Toronto, Dept Surg, Toronto, ON, Canada

[47] Unity Hlth Toronto, Dept Surg, Toronto, ON, Canada

[48] Unity Hlth Toronto, Dept Crit Care Med, Toronto, ON, Canada

来源：

NATURE MEDICINE | 2022年 / 28卷 / 06期

基金：

“创新英国”项目; 英国医学研究理事会; 英国惠康基金; 加拿大健康研究院; 美国国家卫生研究院;

关键词：

SEPTIC SHOCK; PRECISION MEDICINE; STAGING SYSTEM; SEPSIS; DEFINITIONS; OUTCOMES; TRIAL; ARDS; CLASSIFICATION; SUBPHENOTYPES;

D O I：

10.1038/s41591-022-01843-x

中图分类号：

Q5 [生物化学]; Q7 [分子生物学];

学科分类号：

071010 ; 081704 ;

摘要：

The authors propose a new conceptual model of critical illness that moves away from the current syndrome-based framework in favor of more precise biological descriptors-spurred by mounting translational evidence and insights from Coronavirus Disease 2019 (COVID-19) research. 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.

引用

页码：1141 / 1148

页数：8

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