Newly Published
Editorial Views  |   December 2018
Heterogeneity in Intensive Care: Low Severity Does Not Mean Low Risk!
Author Notes
  • From the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California.
  • Corresponding article on page XXX.
    Corresponding article on page XXX.×
  • Accepted for publication November 4, 2018.
    Accepted for publication November 4, 2018.×
  • Correspondence: Address correspondence to Dr. Gropper: michael.gropper@ucsf.edu
Article Information
Editorial Views / Critical Care
Editorial Views   |   December 2018
Heterogeneity in Intensive Care: Low Severity Does Not Mean Low Risk!
Anesthesiology Newly Published on December 21, 2018. doi:10.1097/ALN.0000000000002537
Anesthesiology Newly Published on December 21, 2018. doi:10.1097/ALN.0000000000002537
Intensivists often treat syndromes rather than diseases. Syndromes are defined as sets of medical signs and symptoms that are correlated with each other and, often, with a particular disease. Therefore, syndromes are heterogeneous entities that may be related to variety of underlying causes. Among the most frequent conditions leading to intensive care unit admission are shock, acute kidney injury, and acute lung injury, all of which are syndromes with diverse causation. In practice, this heterogeneity translates into a wide range of severity and broad potential for evolution and has great implications for research and therapeutics. Acute respiratory distress syndrome (ARDS) is a typical example of a very heterogeneous critical syndrome. Similar to the Acute Kidney Injury Network’s definition for acute kidney injury,1  the recent Berlin definition2  for ARDS was adopted to provide clinicians and researchers with a more specific definition for this entity. Besides refining the diagnostic criterion, the Berlin task force created three severity grades of ARDS (mild, moderate, and severe) based on the Pao2/Fio2 ratio. Within each of these subgroups, the patients are supposed to be more similar, i.e., less heterogeneous.1,2  The article by Pham et al. in this issue of Anesthesiology eloquently shows that mild ARDS is substantially under appreciated.3