The history of intensive care has been littered with too many false dawns. Old management dogma, now derided, have been replaced by new and equally resolute convictions, many of which will, in time, undoubtedly follow a similar course. Retired bundles of care have been replaced by new bundles driven by clinical evangelists and government diktat. Yet these too lack a strong evidence base and can be readily challenged. Homogenizing treatment given to a highly heterogenous patient population that fall under the wide syndromic umbrella of sepsis may offer a minimum standard of care though at the potential cost of compromising outcomes in an individual patient. Likewise, the repeated multicentre trial failures of novel interventional strategies over many decades highlight the need to focus more precisely on the individual’s biological phenotype and adopt a personalized treatment approach. This article will briefly cover these issues and offer directions for the future.

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