Critical care
Personal touch “A
lot of the diseases we see in the ICU represent a frontier of medical knowledge,” says Kiran Reddy of the Department of Anaesthesiology and Critical Care at Beaumont Hospital, Dublin. “We don’t know very much about them. It’s essentially a matter of organ support and giving patients some treatment in the hope they’ll respond.”
Its connection to Covid-19 has brought it to the world’s attention and inspired a wave of new research, but Reddy’s specialism, acute respiratory distress syndrome (ARDS), remains one such condition. Despite improvements in ventilation and fluid management strategies since ARDS was first discovered in 1967, mortality is still high at 30–40%, and, in the words of a 2019 Nature Reviews ‘Primer’ on the condition, it is marked by a “relentless failure of pharmacotherapeutics”. In recent years, however,
Practical Patient Care /
www.practical-patient-care.com
specialists have drawn attention to the heterogeneity of ARDS, sepsis and other critical care syndromes, and broken the overall patient population into more clinically relevant subgroups by measuring their biomarkers. If the success of similar approaches in oncology and asthma are anything to go by, it could lead to a new generation of targeted treatments that change intensive care forever.
Significance of subphenotypes “The idea of a more personalised approach to medicine in this area is probably best documented in asthma,” says Cecilia O’Kane, a clinical professor in the Wellcome Wolfson Institute for Experimental Medicine at Queen’s University Belfast. “Advanced asthma treatments are being very much tailored according to specific subgroups of patients, and we know they do brilliantly with individualised treatment.
51
Given the heterogeneity of patients and the broad defi nition of conditions like acute respiratory distress syndrome and sepsis, precision medicine is as applicable in the ICU as anywhere else. Radhika Holmström speaks to Kiran Reddy of Beaumont Hospital, Dublin, Cecilia O’Kane, clinical professor at Queen’s University Belfast, and Imperial College London’s Anthony Gordon – authors of a recent review article on the topic – about how biomarkers can be used to identify subphenotypes of each condition and tailor treatment to improve patient outcomes.
Kiryl Lis/
Shutterstock.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59
