The Promise of Personalized Care in the Intensive Care Unit

P ersonalized medicine, the “careful matching of your biology to your medical care,”1 holds great promise for improving patient outcomes. All health professions can apply the principles of personalized medicine within their own disciplines, and personalized approaches should drive interdisciplinary care. Neither personalized medicine nor the broader concept of personalized care delivered by the interdisciplinary team have been widely applied to critically ill patients. The lack of personalized care may seem counterintuitive, since the care of critically ill patients is highly individualized. Although critical care clinicians usually do not know the patient prior to hospitalization, they quickly acquaint themselves with the problems that brought the patient to the intensive care unit (ICU) and with the preexisting diseases that may impact their care and clinical course. Families are involved, and patient and family wishes regarding care are explored. So how does personalized care differ from the individualized patient-centered care we currently provide, and why is personalized care so vital to improving outcomes for critically ill patients? Currently, individualization of care for ICU patients focuses on quantitative point-in-time data gathered directly from the patient (such as vital signs, laboratory values, and diagnostic test results) and on psychosocial and spiritual aspects of care. Pharmacologic dosing may be tailored using generic formulas based on patient weight or organ function (as reflected, for example, by creatinine clearance), many of which were originally developed for other patient populations. Other treatments are frequently driven by “one size fits all” guidelines, with ongoing calibration based on a patient’s response to therapy. When we individualize care, we generally do so on a case-bycase basis driven by available clinical knowledge and intuition. Where choices must be made, patient and family decisions are usually based on their values and preferences, ideally informed by discussion with providers about the likely potential risks and benefits of available therapeutic alternatives. However, assessing potential risks and benefits for a unique patient is difficult.