Redefining critical illness

Area of Science:

• Critical care medicine
• Translational research
• Pathobiology

Background:

• Current critical care medicine relies on syndromes, which are heterogeneous and may respond variably to treatments.
• Evidence from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection highlights limitations of the syndrome-based framework.

Purpose of the Study:

• To propose a shift from syndrome-based classification to a focus on underlying biological mechanisms in critical illness.
• To explore how recent basic science and clinical research can inform a new conceptual model for critical illness.

Main Methods:

• Review of recent findings in basic science and clinical research in critical care.
• Discussion of how these findings can inform a new conceptual model of critical illness.

Main Results:

• The current syndrome-based framework for critical illness may be inadequate.
• Focusing on underlying biological changes offers a more precise approach to understanding and treating critical illness.

Conclusions:

• A new conceptual model de-emphasizing syndromes and focusing on biological changes is proposed.
• This approach is hypothesized to accelerate research, improve understanding of critical illness pathobiology, and enhance clinical practice and trial design.