Critical care uses syndromic definitions to describe patient groups for clinical practice and research. There is growing recognition that a "precision medicine" approach is required and that integrated biologic and physiologic data identify reproducible subpopulations that may respond differently to treatment. This article reviews the current state of the field and considers how to successfully transition to a precision medicine approach. To impact clinical care, identification of subpopulations must do more than differentiate prognosis. It must differentiate response to treatment, ideally by defining subgroups with distinct functional or pathobiological mechanisms (endotypes). There are now multiple examples of reproducible subpopulations of sepsis, acute respiratory distress syndrome, and acute kidney or brain injury described using clinical, physiological, and/or biological data. Many of these subpopulations have demonstrated the potential to define differential treatment response, largely in retrospective studies, and that the same treatment-responsive subpopulations may cross multiple clinical syndromes (treatable traits). To bring about a change in clinical practice, a precision medicine approach must be evaluated in prospective clinical studies requiring novel adaptive trial designs. Several such studies are underway, but there are multiple challenges to be tackled. Such subpopulations must be readily identifiable and be applicable to all critically ill populations around the world. Subdividing clinical syndromes into subpopulations will require large patient numbers. Global collaboration of investigators, clinicians, industry, and patients over many years will therefore be required to transition to a precision medicine approach and ultimately realize treatment advances seen in other medical fields.

中文翻译：

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从 ICU 综合征到 ICU 亚表型：ICU 发展精准医学的共识报告和建议。


重症监护使用综合征定义来描述临床实践和研究的患者群体。人们越来越认识到需要“精准医学”方法，并且综合生物学和生理学数据可以识别可能对治疗有不同反应的可重复亚群。本文回顾了该领域的现状，并探讨了如何成功过渡到精准医疗方法。为了影响临床护理，亚群的识别必须不仅仅只是区分预后。它必须区分对治疗的反应，理想情况下是通过定义具有不同功能或病理生物学机制（内型）的亚组。现在有多个使用临床、生理和/或生物学数据描述的脓毒症、急性呼吸窘迫综合征和急性肾或脑损伤的可重复亚群的例子。许多这些亚群已证明有可能定义不同的治疗反应，主要是在回顾性研究中，并且相同的治疗反应亚群可能跨越多种临床综合征（可治疗的特征）。为了改变临床实践，必须在需要新颖的适应性试验设计的前瞻性临床研究中评估精准医学方法。多项此类研究正在进行中，但仍有许多挑战需要解决。这些亚人群必须易于识别，并且适用于世界各地的所有危重患者。将临床综合征细分为亚群需要大量患者。 因此，需要研究人员、临床医生、行业和患者多年的全球合作，才能过渡到精准医学方法，并最终实现其他医学领域的治疗进步。