Critical Illness and Critical Care: Perturbing a perturbed complex system

Timothy G. Buchman, Ph.D., M.D.
Past President of Society of Critical Care Medicine
Edison Professor of Surgery
Professor of Anesthesiology and of Medicine,
School of Medicine, Washington University

Humans are robust yet fragile. When illness or injury overwhelms compensatory mechanisms embedded in physiology, one or more life-supports are required. These supports are delivered by critical care physicians in intensive care units. In this lecture, I will review the signatures of selected critical illnesses and discuss present and investigational approaches to treatment. From the perspective of complexity science, present treatments are generally aimed at confining physiological dynamical systems to a very small region of the state space by holding selected measurable parameters invariant: many “stabilized” patients fail to recover. There is preliminary evidence to suggest that injecting variability that emulates ordinary 1/f fluctuations into physiologic supports can accelerate recovery, providing improved outcomes at reduced costs. Transforming critical care to allow and even encourage restoration of normal dynamics will require a paradigm shift and the cooperative efforts of clinicians, experimentalists, theoreticians and analysts from diverse disciplines.

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