Genomic Information Will Affect Future ICU Care

In the future, personal genomic profiles will help to determine patient susceptibility to certain diseases and to define more-targeted, individualized treatments in the intensive care unit (ICU), according to Timothy G. Buchman, M.D., Ph.D., in a Society of Critical Care Medicine briefing held at the annual Critical Care Congress in San Diego (CA, USA).

Currently, the focus is on acute illness, not the patient's genetically controlled response to that illness, says Dr. Buchman. Some patients have a genetic susceptibility to certain endemic diseases such as leprosy, tuberculosis, and AIDS, while others are resistant. Some genetic variances allow people to carry an extremely high level of endotoxins without becoming ill. Still other variances create sensitivity or resistance to certain therapeutics. For example, one out of every six asthma patients is genetically insensitive to scheduled administration of certain inhalers. While some disorders, such as diabetes, hypertension, and heart disease, do not follow patterns of single gene inheritance, they do run in families and have some heritable component.

As a result of the genomic revolution, doctors can look at their patients and their cells as a whole. Several research advances have already affected critical care, including microarray technology, which has shown that cells respond differently at a molecular level to different organisms, including viruses, bacteria, and fungi. Dr. Buchman predicts that bedside diagnostics will be commonly used within the next five to seven years. Because doctors are going to need specific genetic data about each patient, caregivers will have to ensure that these sensitive data remain private.

"The critical care profession recognizes that at the time of acute illness, patient outcome is dependent not only on quality treatment but also on heritable risk,” said Dr. Buchman, who is professor of surgery at the Washington University School of Medicine (St. Louis, MO, USA). "The issue is not whether there's going to be genetic testing and individualized care, the issue is how we are going to manage the process.”




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Society of Critical Care Medicine