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Báo cáo y học: "Novel representation of physiologic states during critical illness and recovery"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Novel representation of physiologic states during critical illness and recovery. | Buchman Critical Care 2010 14 127 http ccforum.eom content 14 2 127 CRITICAL CARE COMMENTARY L__ Novel representation of physiologic states during critical illness and recovery Timothy G Buchman See related research by Cohen etal. http ccforum.eom content 14 1 R10 Abstract Clinicians depend on recognizing particular critical illnesses such as sepsis and cardiac failure from patterns of vital signs. The relationship between a vital sign pattern and a specific condition is explored. In the previous issue of Critical Care Cohen and colleagues 1 offer a new approach to identifying and describing states of critical illness. The work follows a path launched by John Siegel and colleagues 2 3 almost two decades ago toward letting the data themselves define densely populated regions of physiologic state space that collectively represent a clinical condition. Areas of densely and of sparsely populated regions of the state space arise spontaneously from interconnections among various organ systems and their constituent tissues 4 . What Cohen and colleagues have added to the analysis are bioinformatic tools developed applied and validated in the service of genomic analysis. Heat maps representing relative expression and hierarchical clustering give a sense of similarity of states and their adjacencies in physiologic state space respectively. But the report has a deeper significance that perhaps can be grasped by inspection of Figure 1. When we clinicians glance up at a bedside physiologic display monitor and look at the heart rate and blood pressure we obtain the picture seen in Figure 1a. The difficulty is that the present state can be reached from many trajectories so that the important inverse problem namely what condition led to the particular values of the blood pressure and heart rate is ill posed in the sense of Hadamard 5 6 . There are essentially an infinite number of trajectories that lead to this point. One approach to Correspondence tbuchma@emory.edu Emory