Intensive care medicine in 2050: the ICU in vivo

Excerpt

When speculating on how an intensive care unit (ICU) might appear in 2050, the famous saying of the Noble laureate physicist Niels Bohr comes to mind: “prediction is very difficult, especially if it concerns the future.” Nevertheless, the purpose of this paper is to speculate on the diagnostic developments that will define the landscape of the ICU in 2050. In doing so it should be noted that it is the view of a physiologist interested in intensive care medicine and not that of an intensivist. Although it is likely that the future will be dominated by personalized medicine [1], a concept will have to emerge which will be much more suited to the critically ill patient than its current understanding based mainly on genomics and biomarkers [2]. Personalized medicine will need to be more focused on the continuous assessment of the function of the various physiological compartments of the individual critically ill patient [3, 4]. We have termed this concept personalized physiological medicine, as a version of personalized medicine that is more closely related to the physiological needs of the critically ill patient [5]. The principles of personalized physiological medicine are defined by continuous assessment of the physiological reserve and frailty of the patient, the function of the various organ systems, the hierarchy and coherence of the cardiovascular system [6], and finally the integration of physiological variables and therapeutic interventions for control of organ function ([5]; Fig. 1). Personalized physiological medicine could be, in my opinion, the defining platform for the ICU of 2050 as it includes basic concepts from engineering for the control of complex systems [7]. To achieve this aim, continuous and quantitative measurements of essential physiological parameters that relate to organ and cellular function will be required using tailor-made point-of-care technology. To achieve precision medicine, devices and sensors will have to be placed as close as possible to the organs and cells of the patient.

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