? Neurological system: Advances have been made in terms of neuro-monitoring modalities and in treatments for specific neurological disease (for example, thrombolytic therapy for ischemic Imatinib Mesylate buy stroke and therapeutic cooling after cardiac arrest). However, there have been relatively few advances in the approach to many other neurological processes requiring intensive care (for example, traumatic brain injury), and mortality and morbidity rates in such patients remain high. The development of new drugs for neurological disorders has been particularly disappointing.Too many syndromes?By describing new entities and coining new syndromes, we thought that diagnosis would be more specific and studies could be performed more easily on more homogeneous groups of patients, thus aiding and abetting the development of new therapies.

However, this may not be the case. For example, introducing the concept of the systemic inflammatory response syndrome (SIRS) did not prove to be helpful, and whether the AKI approach is really better than acute renal dysfunction or failure is not at all certain. It could even be argued that existing definitions of ALI and ARDS have not resulted in better management given that the only positive study outcome is that we should limit tidal volumes and plateau airway pressure in patients meeting these criteria. We have ended up grouping many heterogeneous patients together; this may have contributed to our lack of therapeutic progress in this area.Is less better?Undoubtedly, we have learned over the past 30 years that more is not necessarily better.

We have, in fact, realized that fewer interventions or less of a particular intervention is frequently associated with better outcomes. Previously, a primary goal of acute care management was to restore all measured variables to their ‘normal’ values whether they were laboratory values, such as electrolytes, blood gases, or hematocrit, or physiological values, such as cardiac output or urine output. For example, we now use fewer blood transfusions since the multicenter Canadian study by Hebert and colleagues [10] that noted that a hemoglobin transfusion trigger of 7 g/dL resulted in no increase in mortality when compared with transfusions to a hemoglobin of greater than 9 g/dL.

Invasive hemodynamic monitoring (for example, the pulmonary artery catheter) has been largely replaced by technologies that are less invasive, even though these lack direct measures Batimastat of pulmonary vascular pressures and mixed venous oxygen saturation.Thanks to the development of interventional radiology, numerous therapeutic interventions that once required surgery are now accomplished less invasively. Abscess drainage, stent placement, interruption of torrential gastro intestinal bleeding, coiling of intracerebral aneurysms, and percutaneous coronary intervention are only a few salient examples.