Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands.
Crit Care. 2019 Jun 14;23(Suppl 1):126. doi: 10.1186/s13054-019-2416-7.
This paper discusses the physiological and technological concepts that might form the future of critical care medicine. Initially, we discuss the need for a personalized approach and introduce the concept of personalized physiological medicine (PPM), including (1) assessment of frailty and physiological reserve, (2) continuous assessment of organ function, (3) assessment of the microcirculation and parenchymal cells, and (4) integration of organ and cell function for continuous therapeutic feedback control. To understand the cellular basis of organ failure, we discuss the processes that lead to cell death, including necrosis, necroptosis, autophagy, mitophagy, and cellular senescence. In vivo technology is used to monitor these processes. To this end, we discuss new materials for developing in vivo biosensors and drug delivery systems. Such in vivo biosensors will define the diagnostic platform of the future ICU in vivo interacting with theragnostic drugs. In addition to pharmacological therapeutic options, placement and control of artificial organs to support or replace failing organs will be central in the ICU in vivo of the future. Remote monitoring and control of these biosensors and artificial organs will be made using adaptive physiological mathematical modeling of the critically ill patient. The current state of these developments is discussed.
本文探讨了可能构成未来重症监护医学基础的生理学和技术概念。首先，我们讨论了对个性化方法的需求，并引入了个性化生理学医学（PPM）的概念，包括（1）脆弱性和生理储备评估，（2）器官功能的连续评估，（3）微循环和实质细胞的评估，以及（4）器官和细胞功能的整合，用于持续治疗反馈控制。为了了解器官衰竭的细胞基础，我们讨论了导致细胞死亡的过程，包括坏死、坏死性凋亡、自噬、线粒体自噬和细胞衰老。体内技术用于监测这些过程。为此，我们讨论了开发体内生物传感器和药物输送系统的新材料。此类体内生物传感器将定义未来 ICU 的诊断平台，与治疗诊断药物在体内相互作用。除了药理学治疗选择外，人工器官的放置和控制以支持或替代衰竭的器官将是未来 ICU 中的核心内容。使用危重病患者的适应性生理数学模型对这些生物传感器和人工器官进行远程监测和控制。讨论了这些发展的现状。
