Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, Private Bag 4800, New Zealand.
Ann Intensive Care. 2011 May 5;1(1):11. doi: 10.1186/2110-5820-1-11.
Critically ill patients are highly variable in their response to care and treatment. This variability and the search for improved outcomes have led to a significant increase in the use of protocolized care to reduce variability in care. However, protocolized care does not address the variability of outcome due to inter- and intra-patient variability, both in physiological state, and the response to disease and treatment. This lack of patient-specificity defines the opportunity for patient-specific approaches to diagnosis, care, and patient management, which are complementary to, and fit within, protocolized approaches.Computational models of human physiology offer the potential, with clinical data, to create patient-specific models that capture a patient's physiological status. Such models can provide new insights into patient condition by turning a series of sometimes confusing clinical data into a clear physiological picture. More directly, they can track patient-specific conditions and thus provide new means of diagnosis and opportunities for optimising therapy.This article presents the concept of model-based therapeutics, the use of computational models in clinical medicine and critical care in specific, as well as its potential clinical advantages, in a format designed for the clinical perspective. The review is presented in terms of a series of questions and answers. These aspects directly address questions concerning what makes a model, how it is made patient-specific, what it can be used for, its limitations and, importantly, what constitutes sufficient validation.To provide a concrete foundation, the concepts are presented broadly, but the details are given in terms of a specific case example. Specifically, tight glycemic control (TGC) is an area where inter- and intra-patient variability can dominate the quality of care control and care received from any given protocol. The overall review clearly shows the concept and significant clinical potential of using computational models in critical care medicine.
危重症患者对治疗和护理的反应存在很大差异。这种变异性以及对改善治疗效果的追求，导致了协议化护理的广泛应用，以减少护理的变异性。然而，协议化护理并不能解决由于患者内在和外在的变异性，以及生理状态和对疾病及治疗的反应的变异性而导致的结果变异性。这种缺乏患者特异性定义了针对患者的诊断、护理和患者管理的个体化方法的机会，这些方法是互补的，并适应协议化方法。
人类生理学的计算模型提供了利用临床数据创建捕捉患者生理状态的个体化模型的潜力。这些模型可以通过将一系列有时令人困惑的临床数据转化为清晰的生理图像，为患者的病情提供新的见解。更直接地说，它们可以跟踪患者特定的情况，从而提供新的诊断方法和优化治疗的机会。
本文提出了基于模型的治疗学的概念，即在临床医学和危重病学中具体使用计算模型，以及其潜在的临床优势，采用了专为临床视角设计的格式。综述以一系列问答的形式呈现。这些方面直接解决了有关模型的定义、如何使其具有患者特异性、可以用于哪些方面、其局限性以及最重要的是，构成充分验证的问题。
为了提供一个具体的基础，这些概念被广泛地提出，但细节是根据一个具体的案例来给出的。具体来说，严格血糖控制（TGC）是一个存在患者内在和外在变异性会主导护理控制和从任何给定方案中获得的护理质量的领域。总的来说，本综述清楚地展示了在危重病医学中使用计算模型的概念和显著的临床潜力。
