Precision medicine for all? Challenges and opportunities for a precision medicine approach to critical illness

• Published in: Critical care (London, England) Vol. 21; no. 1; pp. 257 - 11
• Main Authors: Seymour, Christopher W., Gomez, Hernando, Chang, Chung-Chou H., Clermont, Gilles, Kellum, John A., Kennedy, Jason, Yende, Sachin, Angus, Derek C.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 18.10.2017; BioMed Central Ltd; BMC
• Subjects: Breast cancer; Care and treatment; Clinical trials; Critical care; Critical Care Medicine; Critical illness; Critically ill persons; Cytokines; Emergency Medicine; Gene expression; Genotype & phenotype; Intensive; Medicine; Medicine & Public Health; Mortality; Mutation; Patients; Phenotypes; Precision medicine; Researchers; Review; Sepsis; The future of critical care; United States; Precision medicine; Critical illness; Phenotypes
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1466-609X; 1366-609X
• DOI: 10.1186/s13054-017-1836-5

All of medicine aspires to be precise, where a greater understanding of individual data will lead to personalized treatment and improved outcomes. Prompted by specific examples in oncology, the field of critical care may be tempted to envision that complex, acute syndromes could bend to a similar reductionist philosophy—where single mutations could identify and target our critically ill patients for treatment. However, precision medicine faces many challenges in critical care. These include confusion about terminology, uncertainty about how to divide patients into discrete groups, the challenges of multi-morbidity, scale, and the need for timely interventions. This review addresses these challenges and provides a translational roadmap spanning preclinical work to identify putative treatment targets, novel designs for clinical trials, and the integration of the electronic health record to implement precision critical care for all.