Mervyn Singer

Bio

Professor of Intensive Care Medicine at University College London, UK. Proud of taking an iconoclastic view of illness that drives my clinical practice and research agenda in sepsis, multi-organ failure, tissue oxygenation, monitoring etc. Am happy to air these views publicly and generate debate and alternative thinking!


Is survival predetermined in the critically ill

Many, many studies show outcome can be predicted early, even in the ED - if so, do we need to adopt a different approach to management?
Multiple biomarkers – physiological, biochemical, biological – can prognosticate early in critical illness, even in the ED. This implies the die is already cast (literally as well as figuratively) so we are simply prolonging death is those predetermined to die. We thus need to adopt a completely different strategy for such patients. This also applies to trial design, especially where survival is the endpoint.

Should we De-stress the Distressed?

Multi-organ failure is a manifestation of decompensated stress; de-stressing should improve outcomes

There is a rich literature showing excess stress – psychological, pharmacological or physiological – results in similar physical and cognitive manifestations. Critical illness is the perfect example of this manifestation of decompensated stress (“allostatic overload”). Failed organs frequently look normal histologically yet are functionally inactive, despite many varied insults/stressors triggering the failure. These organs regain their functionality prior to patient recovery suggesting, in most cases, reversibility. If this hypothesis were true, de-stressing manoeuvres should improve outcomes … and they do, at least in specific human conditions and animal models. Grasping this concept offers a much more holistic approach than we use at present and may lead to improved outcomes.


There is a rich literature showing excess stress – psychological, pharmacological or physiological – results in similar physical and cognitive manifestations. Critical illness is the perfect example of this manifestation of decompensated stress (“allostatic overload”). Failed organs frequently look normal histologically yet are functionally inactive, despite many varied insults/stressors triggering the failure. These organs regain their functionality prior to patient recovery suggesting, in most cases, reversibility. If this hypothesis were true, de-stressing manoeuvres should improve outcomes … and they do, at least in specific human conditions and animal models. Grasping this concept offers a much more holistic approach than we use at present and may lead to improved outcomes.



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