The specialty of intensive care medicine grew out of the realisation that critically ill patients needed more attention and specialised treatment than could be provided on a general ward, and that many of these patients had similar clinical problems and processes, so management would be facilitated if they were grouped together in one place.

As we are increasingly able to better characterise patients, our ability to identify subgroups within subgroups will increase until we reach the point at which each subgroup consists of just one patient (Gattinoni et al. 2016). This will be true precision medicine, in which medical treatments will be customised to an individual’s molecular and genetic makeup. Although this approach is already being used in oncology, in the ICU environment, with the very rapid changes that occur in patient status, requiring regular treatment adjustment and thus necessitating repeated phenotypic profiling, true precision medicine is still some way off.

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