Critical care: advances and future perspectives
- 1 October 2010
- journal article
- Published by Elsevier BV in The Lancet
- Vol. 376 (9749), 1354-1361
- https://doi.org/10.1016/s0140-6736(10)60575-2
Abstract
Intensive care offers a standard of monitoring, intervention, and organ support that cannot be readily delivered in a general ward. Its expansion in the past few decades, including the creation of emergency and outreach teams, emphasises that intensive care has an increasingly prominent role within the hospital. Although outcomes are clearly improving, intensive care remains a nascent specialty in which we are still learning how to harness a powerful ability to manipulate physiology, biochemistry, and immunology to achieve best outcomes for the patient. The results of many multicentre studies have not lent support to, or have even confounded, expectations, drawing attention to several issues related to patient heterogeneity, trial design, and elucidation of underlying pathophysiological processes. However, these results have generated constructive introspection and reappraisal of treatments and management strategies that have benefited the patient. In addition to the medical, financial, and logistical challenges in the future, exciting opportunities will arise as new developments in diagnostic tests, therapeutic interventions, and technology are used to exploit an increasing awareness of how critical illness should be managed.This publication has 78 references indexed in Scilit:
- Induced hypothermia and fever control for prevention and treatment of neurological injuriesThe Lancet, 2008
- Multicenter, randomized, controlled trials evaluating mortality in intensive care: Doomed to fail?Critical Care Medicine, 2008
- Intensive Insulin Therapy and Pentastarch Resuscitation in Severe SepsisNew England Journal of Medicine, 2008
- Sepsis: rethinking the approach to clinical researchJournal of Leukocyte Biology, 2008
- Mortality and length-of-stay outcomes, 1993–2003, in the binational Australian and New Zealand intensive care adult patient database*Critical Care Medicine, 2008
- Sepsis in European intensive care units: Results of the SOAP study*Critical Care Medicine, 2006
- Noninvasive Positive-Pressure Ventilation for Respiratory Failure after ExtubationNew England Journal of Medicine, 2004
- Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: Effect on survival in patients with septic shock*Critical Care Medicine, 2004
- Critical care without wallsCurrent Opinion in Critical Care, 2002
- Increased Mortality Associated with Growth Hormone Treatment in Critically Ill AdultsNew England Journal of Medicine, 1999