Half empty or half full?*

Abstract

Abstract : Logic, anecdote, and data collectively suggest that early detection and prompt intervention in critical illness improve outcomes at lower costs. Process engineering (e.g., standardization and aggregation of interventions into bundles ) has increased care effectiveness. The next step involves transforming critical care from reactive to preemptive practice through recognition of impending collapse. The excursion of conventional measures, such as traditional vital signs (VS), urine output, and lactate, beyond normal ranges is insufficient to predict critical illness. First, such excursions are used to classify established illness. Acute physiology scores depend on those measures such that prediction and occurrence are indistinguishable. Second, they do not distinguish decompensation that requires life-saving interventions (LSIs) from compensated responses; two decades of experience with the systemic inflammatory response syndrome criteria suggest as much. Third, they occur in the absence of pathology: athletes commonly display hyperthermia, tachycardia, tachypnea, relative hypotension, and low urine output.