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Personalized Critical Care Medicine

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Personalized Medicine in Anesthesia, Pain and Perioperative Medicine

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Abstract

The vast clinical heterogeneity seen in patients with critical illness provides ample opportunity for instituting personalized medicine. It can improve various aspects of critical care including risk stratification, diagnosis, treatment plans and response, prognostication, and research. Although the current clinical utilization is limited, tools abound in the research space. They include biomarkers, and methods using omics-based technology and large population level data. For example, Neutrophil gelatinase-associated lipocalin (NGAL) is biomarker for early identification of acute kidney injury, and soluble receptor for advanced glycation end-products (sRAGE) may identify high-risk patients with acute respiratory distress syndrome. Omics-based techniques can help with early diagnosis, identifying unknown endotypes, and to investigate endotype specific treatment. For instance, a hyperinflammatory endotype of acute respiratory distress syndrome identified using latent class analysis identifies patients who might preferentially benefit from restrictive fluid management or steroids. Also, various gene transcription panels have been used to differentiate sepsis from non-infectious inflammation. Single nucleotide polymorphisms can be used to predict variations in clinical response to certain medications like opioids, clopidogrel and coumadin. With availability of detailed physiological and laboratory data through electronic medical records, complex machine learning algorithms and artificial intelligence-based systems are being used to predict sepsis and acute kidney injury. Personalized medicine in critical care setting is rife with challenges, and many of these tools need further research and development to be incorporated into clinical practice. We envision a future where personalized medicine guides all aspects of decision making and therapy, thereby, improve outcomes in critically ill patients.

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  1. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Aditi Balakrishna & Abraham Sonny

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    Ali Dabbagh

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Balakrishna, A., Sonny, A. (2021). Personalized Critical Care Medicine. In: Dabbagh, A. (eds) Personalized Medicine in Anesthesia, Pain and Perioperative Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-53525-4_10

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