The future of the ICU

The future of the ICU

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This three-part session during Sunday’s programme at Euroanaesthesia looked into the future,  at how intensive care units (ICU) might look in the decades to come.

In his talk ‘the era of precision medicine’, Professor Jean-Louis Vincent (Dept of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium) discussed how ICU patients are very heterogeneous and cannot realistically all be expected to respond in a similar fashion to the same treatment.

“This is supported by the vast numbers of negative trials that have targeted mortality in general ICU patient populations,” explained Prof Vincent. “A key solution to this problem, and indeed, the future of intensive care medicine in terms of both clinical trial design and clinical practice, is to personalise therapy.”

He said that therapies and therapeutic targets need to be selected for individual patients and patients should only be prescribed an intervention, or enrolled in a clinical trial of a new therapy, if they are likely to benefit from that treatment. Similarly, treatment targets need to be adapted to the individual patient taking into account past medical history, comorbitidity, clinical examination, haemodynamic status and age, among other factors.

He concluded by saying: “Identification of patient phenotypes will help to develop targeted therapies and artificial intelligence will provide an important guide to therapy. In this new era, we will move up the ‘three Ps’ pyramid, from one therapy for all in ‘poorly characterised patient populations’, to more appropriate therapies for small subgroups of patients in ‘personalised medicine’, to the ultimate ‘precision medicine’ in which treatments will be customised for each individual.”

In the second talk, the typology of ICU patients in 2050 was addressed by Professor Maurizio Cecconi, Head of the Anaesthesia and Intensive Care Department at Humanitas Research Hospital, Rozzano, Italy, and President-elect of the European Society of Intensive Care Medicine (ESICM).

“In 2050 our patients and their families will expect us to be precise and human with our ICU treatment,” explained Prof Cecconi. “The ageing population and the future advances in medicine mean that the ICU patient of the future will be older and more complex.”

He believes that hospitals will be smaller with a focus mainly on the most acute patients, with the less severe patients managed via telemedicine at home or in less acute facilities. On the other hand, ICUs will be bigger and represent a high percentage of the total hospital beds.

Prof Cecconi said: “Information will flow as a continuum from health to disease. When patients arrive at the hospital, we will know immediately their degree of fitness or frailty, their main reason for their admission and we will characterise their phenotype precisely.”

He added: “This in turn will allow us to use personalised precision medicine for every single patient. Artificial Intelligence will be part of our way of working. It will take care of the most time-consuming tasks (such as ordering exams and blood tests depending on the patient’s condition). It will bring augmented reality to our eyes and allow us to be faster and better in diagnosing and treating, allowing us to spend more time with our patients. Virtual reality will bring family environments to our patients so they will be able to attend a grandson’s birthday party or graduation ceremony.”

He concluded: “ICU survivors will not just survive, they will be helped to have a personalised rehabilitation to go back to a good quality of life.”

The final talk discussed how extracorporeal membrane oxygenation (ECMO) will feature in the ICUs of the future, and was given by Professor Antonio Pesenti of the Polyclinico of Milan and Milan University, Italy.