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Published in: Intensive Care Medicine 10/2017

01-10-2017 | Editorial

Intensive care medicine in 2050: precision medicine

Author: Hector R. Wong

Published in: Intensive Care Medicine | Issue 10/2017

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Excerpt

By 2050, intensive care medicine will evolve from reliance on treatment protocols, guidelines, consensus definitions, and organ support to regularly applying the principles of precision medicine. Precision medicine entails the customization of therapies based on unique features of an individual patient or of patient subtypes. At a fundamental level, we already practice precision medicine. For example, among patients with cardiovascular shock, we select different pharmacologic agents on the basis of the etiology of shock. However, the hope is that the field can evolve toward a more granular form of precision medicine, wherein we directly address the unique molecular and biological features of an individual patient. For example, the rapidly evolving discipline of pharmacogenomics provides an opportunity to tailor drug selection and dosing based on genetic variants modifying drug response and metabolism [1]. …
Literature
1.
go back to reference Dickmann LJ, Ware JA (2016) Pharmacogenomics in the age of personalized medicine. Drug Discov Today Technol 21(22):11–16CrossRefPubMed Dickmann LJ, Ware JA (2016) Pharmacogenomics in the age of personalized medicine. Drug Discov Today Technol 21(22):11–16CrossRefPubMed
3.
go back to reference Wong HR, Atkinson SJ, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, Weiss SL, Fitzgerald JC, Checchia PA, Meyer K, Quasney M, Hall M, Gedeit R, Freishtat RJ, Nowak J, Raj SS, Gertz S, Lindsell CJ (2016) Combining prognostic and predictive enrichment strategies to identify children with septic shock responsive to corticosteroids. Crit Care Med 44:e1000–e1003CrossRefPubMed Wong HR, Atkinson SJ, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, Weiss SL, Fitzgerald JC, Checchia PA, Meyer K, Quasney M, Hall M, Gedeit R, Freishtat RJ, Nowak J, Raj SS, Gertz S, Lindsell CJ (2016) Combining prognostic and predictive enrichment strategies to identify children with septic shock responsive to corticosteroids. Crit Care Med 44:e1000–e1003CrossRefPubMed
4.
go back to reference Langley RJ, Tsalik EL, van Velkinburgh JC, Glickman SW, Rice BJ, Wang C, Chen B, Carin L, Suarez A, Mohney RP, Freeman DH, Wang M, You J, Wulff J, Thompson JW, Moseley MA, Reisinger S, Edmonds BT, Grinnell B, Nelson DR, Dinwiddie DL, Miller NA, Saunders CJ, Soden SS, Rogers AJ, Gazourian L, Fredenburgh LE, Massaro AF, Baron RM, Choi AM, Corey GR, Ginsburg GS, Cairns CB, Otero RM, Fowler VG Jr, Rivers EP, Woods CW, Kingsmore SF (2013) An integrated clinico-metabolomic model improves prediction of death in sepsis. Sci Transl Med 5:195ra95CrossRefPubMedPubMedCentral Langley RJ, Tsalik EL, van Velkinburgh JC, Glickman SW, Rice BJ, Wang C, Chen B, Carin L, Suarez A, Mohney RP, Freeman DH, Wang M, You J, Wulff J, Thompson JW, Moseley MA, Reisinger S, Edmonds BT, Grinnell B, Nelson DR, Dinwiddie DL, Miller NA, Saunders CJ, Soden SS, Rogers AJ, Gazourian L, Fredenburgh LE, Massaro AF, Baron RM, Choi AM, Corey GR, Ginsburg GS, Cairns CB, Otero RM, Fowler VG Jr, Rivers EP, Woods CW, Kingsmore SF (2013) An integrated clinico-metabolomic model improves prediction of death in sepsis. Sci Transl Med 5:195ra95CrossRefPubMedPubMedCentral
5.
go back to reference Wong HR, Salisbury S, Xiao Q, Cvijanovich NZ, Hall M, Allen GL, Thomas NJ, Freishtat RJ, Anas N, Meyer K, Checchia PA, Lin R, Shanley TP, Bigham MT, Sen A, Nowak J, Quasney M, Henricksen JW, Chopra A, Banschbach S, Beckman E, Harmon K, Lahni P, Lindsell CJ (2012) The pediatric sepsis biomarker risk model. Crit Care 16:R174CrossRefPubMedPubMedCentral Wong HR, Salisbury S, Xiao Q, Cvijanovich NZ, Hall M, Allen GL, Thomas NJ, Freishtat RJ, Anas N, Meyer K, Checchia PA, Lin R, Shanley TP, Bigham MT, Sen A, Nowak J, Quasney M, Henricksen JW, Chopra A, Banschbach S, Beckman E, Harmon K, Lahni P, Lindsell CJ (2012) The pediatric sepsis biomarker risk model. Crit Care 16:R174CrossRefPubMedPubMedCentral
6.
go back to reference Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, Weiss SL, Fitzgerald J, Checchia PA, Meyer K, Quasney M, Hall M, Gedeit R, Freishtat RJ, Nowak J, Raj SS, Gertz S, Howard K, Harmon K, Lahni P, Frank E, Hart TC, Nguyen TC, Lindsell CJ (2016) PERSEVERE II: redefining the pediatric sepsis biomarker risk model with septic shock phenotype. Crit Care Med 44:2010–2017CrossRefPubMed Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, Weiss SL, Fitzgerald J, Checchia PA, Meyer K, Quasney M, Hall M, Gedeit R, Freishtat RJ, Nowak J, Raj SS, Gertz S, Howard K, Harmon K, Lahni P, Frank E, Hart TC, Nguyen TC, Lindsell CJ (2016) PERSEVERE II: redefining the pediatric sepsis biomarker risk model with septic shock phenotype. Crit Care Med 44:2010–2017CrossRefPubMed
7.
go back to reference Sweeney TE, Perumal TM, Henao R, Nichols M, Howrylak JA, Choi AM, Bermejo-Martin JF, Almansa R, Tamayo E, Davenport EE, Burnham KL, Hinds CJ, Knight JC, Kingsmore SF, Woods CW, Ginsburg GS, Wong HR, Parnell GP, Tang B, Moldawer LL, Moore FE, Omberg L, Khatri P, Tsalik EL, Mangravite LM, Langley RJ (2016) Mortality prediction in sepsis via gene expression analysis: a community approach. bioRxiv. doi:10.1101/095489 Sweeney TE, Perumal TM, Henao R, Nichols M, Howrylak JA, Choi AM, Bermejo-Martin JF, Almansa R, Tamayo E, Davenport EE, Burnham KL, Hinds CJ, Knight JC, Kingsmore SF, Woods CW, Ginsburg GS, Wong HR, Parnell GP, Tang B, Moldawer LL, Moore FE, Omberg L, Khatri P, Tsalik EL, Mangravite LM, Langley RJ (2016) Mortality prediction in sepsis via gene expression analysis: a community approach. bioRxiv. doi:10.​1101/​095489
8.
go back to reference Meyer NJ, Feng R, Li M, Zhao Y, Sheu CC, Tejera P, Gallop R, Bellamy S, Rushefski M, Lanken PN, Aplenc R, O’Keefe GE, Wurfel MM, Christiani DC, Christie JD (2013) IL1RN coding variant is associated with lower risk of acute respiratory distress syndrome and increased plasma IL-1 receptor antagonist. Am J Respir Crit Care Med 187:950–959CrossRefPubMedPubMedCentral Meyer NJ, Feng R, Li M, Zhao Y, Sheu CC, Tejera P, Gallop R, Bellamy S, Rushefski M, Lanken PN, Aplenc R, O’Keefe GE, Wurfel MM, Christiani DC, Christie JD (2013) IL1RN coding variant is associated with lower risk of acute respiratory distress syndrome and increased plasma IL-1 receptor antagonist. Am J Respir Crit Care Med 187:950–959CrossRefPubMedPubMedCentral
9.
go back to reference Meyer NJ, Ferguson JF, Feng R, Wang F, Patel PN, Li M, Xue C, Qu L, Liu Y, Boyd JH, Russell JA, Christie JD, Walley KR, Reilly MP (2014) A functional synonymous coding variant in the IL1RN gene is associated with survival in septic shock. Am J Respir Crit Care Med 190:656–664CrossRefPubMedPubMedCentral Meyer NJ, Ferguson JF, Feng R, Wang F, Patel PN, Li M, Xue C, Qu L, Liu Y, Boyd JH, Russell JA, Christie JD, Walley KR, Reilly MP (2014) A functional synonymous coding variant in the IL1RN gene is associated with survival in septic shock. Am J Respir Crit Care Med 190:656–664CrossRefPubMedPubMedCentral
10.
go back to reference Calfee CS, Delucchi K, Parsons PE, Thompson BT, Ware LB, Matthay MA (2014) Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials. Lancet Respir Med 2:611–620CrossRefPubMedPubMedCentral Calfee CS, Delucchi K, Parsons PE, Thompson BT, Ware LB, Matthay MA (2014) Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials. Lancet Respir Med 2:611–620CrossRefPubMedPubMedCentral
11.
go back to reference Famous KR, Delucchi K, Ware LB, Kangelaris KN, Liu KD, Thompson BT, Calfee CS (2016) ARDS subphenotypes respond differently to randomized fluid management strategy. Am J Respir Crit Care Med 195:331–338 Famous KR, Delucchi K, Ware LB, Kangelaris KN, Liu KD, Thompson BT, Calfee CS (2016) ARDS subphenotypes respond differently to randomized fluid management strategy. Am J Respir Crit Care Med 195:331–338
12.
go back to reference Davenport EE, Burnham KL, Radhakrishnan J, Humburg P, Hutton P, Mills TC, Rautanen A, Gordon AC, Garrard C, Hill AV, Hinds CJ, Knight JC (2016) Genomic landscape of the individual host response and outcomes in sepsis: a prospective cohort study. Lancet Respir Med 4:259–271CrossRefPubMedPubMedCentral Davenport EE, Burnham KL, Radhakrishnan J, Humburg P, Hutton P, Mills TC, Rautanen A, Gordon AC, Garrard C, Hill AV, Hinds CJ, Knight JC (2016) Genomic landscape of the individual host response and outcomes in sepsis: a prospective cohort study. Lancet Respir Med 4:259–271CrossRefPubMedPubMedCentral
13.
go back to reference Burnham KL, Davenport EE, Radhakrishnan J, Humburg P, Gordon AC, Hutton P, Svoren-Jabalera E, Garrard C, Hill AV, Hinds CJ, Knight JC (2016) Shared and distinct aspects of the sepsis transcriptomic response to fecal peritonitis and pneumonia. Am J Respir Crit Care Med. doi:10.1164/rccm.201608-1685OC Burnham KL, Davenport EE, Radhakrishnan J, Humburg P, Gordon AC, Hutton P, Svoren-Jabalera E, Garrard C, Hill AV, Hinds CJ, Knight JC (2016) Shared and distinct aspects of the sepsis transcriptomic response to fecal peritonitis and pneumonia. Am J Respir Crit Care Med. doi:10.​1164/​rccm.​201608-1685OC
14.
go back to reference Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, Weiss SL, Fitzgerald J, Checchia PA, Meyer K, Shanley TP, Quasney M, Hall M, Gedeit R, Freishtat RJ, Nowak J, Shekhar RS, Gertz S, Dawson E, Howard K, Harmon K, Beckman E, Frank E, Lindsell CJ (2015) Developing a clinically feasible personalized medicine approach to pediatric septic shock. Am J Respir Crit Care Med 191:309–315CrossRefPubMedPubMedCentral Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, Weiss SL, Fitzgerald J, Checchia PA, Meyer K, Shanley TP, Quasney M, Hall M, Gedeit R, Freishtat RJ, Nowak J, Shekhar RS, Gertz S, Dawson E, Howard K, Harmon K, Beckman E, Frank E, Lindsell CJ (2015) Developing a clinically feasible personalized medicine approach to pediatric septic shock. Am J Respir Crit Care Med 191:309–315CrossRefPubMedPubMedCentral
15.
go back to reference Wong HR, Sweeney TE, Lindsell CJ (2017) Simplification of a septic shock endotyping strategy for clinical application. Am J Respir Crit Care Med 195:263–265CrossRefPubMed Wong HR, Sweeney TE, Lindsell CJ (2017) Simplification of a septic shock endotyping strategy for clinical application. Am J Respir Crit Care Med 195:263–265CrossRefPubMed
Metadata
Title
Intensive care medicine in 2050: precision medicine
Author
Hector R. Wong
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 10/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-017-4727-y

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