Lactate, blood pressure and infection: tied by faith, untied by man? - Critical Care Science (CCS)

“Diseases are conceptually all alike, although each syndrome is cumbersome in its own way”. This paraphrase of the beginning sentence of Tolstoi’s Anna Kareninna emphasizes the complexity of dealing with a kaleidoscopic mix of signs and symptoms and their interplay. Syndromes are a mainstay of critical care medicine; no other medical specialty deals more regularly with syndromes than intensive care unit (ICU) physicians. Critical illness itself could be considered a syndrome, regardless of its etiology.

Shock is one of the most fascinating syndromes described.⁽⁾ Shock was first described in almost philosophical reports starting in the early nineteenth century, then passed through the “decades of measurement” when it was first studied on physiological grounds, and finally arrived at an age when simple, practical concepts are frequently employed to facilitate patient grouping and prognostication ().⁽⁾ This current approach to medicine should theoretically hasten the development of new therapies, but it can also result in categorization that ignores the initial philosophical and physiological concepts of a syndrome. The same process has occurred with many other syndromes (sepsis, acute respiratory distress syndrome, etc.).^(,)

[…]