Critical Care Review In 2023: Notable Achievements And Advancements – Dr Deepak V

One
of the major achievements in critical care in the year 2023 was the application
of artificial intelligence in critical care. Traditional critical care has
limitations in fully understanding and addressing the complexities of patients’
health, predicting deterioration, and providing timely treatment. AI offers
numerous applications for the critically ill.

Large
language models (LLMs) are adept at summarising vast amounts of medical
literature, assimilating patient vitals, and other parameters from monitors and
charts. They can apply evidence-based medicine to enhance decision-making.
However, a human-in-the-loop strategy, rather than relying solely on AI, will
facilitate better individualised care.

The Society of Critical Care
Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)
have developed processes for de-identifying data to ensure compliance with all
privacy and legal considerations. Last year had seen the successful application
of precision medicine in critical care. It entails the individualization of
therapies based on genomic sequencing .

Advances
in pharmacogenomics offer the opportunity to tailor drug selection and dosing
based on genetic variants that modify drug response and metabolism. Mortality
predictors, utilising a combination of clinical and metabolomics data, aid in
the more efficient allocation of resources.

Patients at higher risk are further
categorised based on predictive models, which identify those who may benefit
from therapies beyond standard care. While standard prediction models
incorporate data such as demographic variables, vitals, and labs, AI-aided
prediction models utilise data from genomics, metabolomics, transcriptomics,
and proteomics, allowing for a more accurate prediction of disease status and
thereby facilitating highly personalised care.

Last
year also witnessed advances in diagnostics in Critical Care. The use of
molecular diagnostics has revolutionised the diagnosis of infections in the
ICU. The results are quicker, with an average turnaround time (TAT) of 2 to 24
hours, compared to 3-5 days with conventional techniques.

Multiplex PCR is the
most commonly used technique, where more than one target sequence can be
amplified in a single tube. This technique has become very useful for the early
identification of the organism causing the infection, which aids in targeted
therapy.

Many
patients in ICUs require mechanical ventilation to support oxygenation and
carbon dioxide removal. However, this machine can introduce several adverse
effects in patients, with the most common being ventilator asynchrony, which
can result in poor clinical outcomes.

Growing evidence suggests that using NAVA
(Neurally Adjusted Ventilatory Assist) guided by the electrical activity of the
diaphragm optimises patient-ventilator synchronisation, thereby avoiding many
ventilator-induced injuries.

Extracorporeal membrane oxygenation
(ECMO) is a life support modality for patients with respiratory or cardiac
failure. Conventionally, patients undergoing ECMO had to remain bedridden and
reliant on a ventilator. However, early mobilisation can expedite recovery.

The
University of Michigan has developed an artificial pump lung system.
Additionally, the paracorporeal ambulatory lung system being developed by the
University of Pittsburgh promises to enhance the treatment of patients awaiting
lung transplants.

Here are the major achievements in
critical care that hold importance for clinicians. The outcome resulting from
these developments will depend on patient selection, expertise in data
interpretation, and clinical acumen.