Progress toward determining the true worth of ongoing practices or value of recent innovations can be glacially slow when we insist on following the conventional stepwise scientific pathway. Moreover, a widely accepted but flawed conceptual paradigm often proves difficult to challenge, modify or reject. Yet, most experienced clinicians, educators and clinical scientists privately entertain untested ideas about how care could or should be improved, even if the supporting evidence base is currently thin or non-existent.

This symposium encouraged experts to share such intriguing but unproven concepts, each based upon what the speaker considered a logical but unproven rationale. Such free interchange invited dialog that pointed toward new or neglected lines of research needed to improve care of the critically ill. In this summary of those presentations, a brief background outlines the rationale for each novel and deliberately provocative unconfirmed idea endorsed by the presenter.

Here are few unproven ideas for future critical care practice:

1. Appropriately dosed vitamin C is a low-risk, low-cost, and potentially helpful addition to our current armamentarium used against sepsis and septic shock.
2. Modulation of the aggressiveness of fluid resuscitation in accordance with measurements of ScvO2 and determination of the base excess component not attributable to lactate—the “alactic base excess,” a simple calculation that could help assess renal compensating ability for the stress of metabolic acidosis.
3. Microcirculatory imaging, cellular function assessment, and tissue-specific therapeutic targeting by nano-biotechnology.
4. We should prioritize maintenance of normal daily psychosocial interactions and variations of activity during the post-resuscitation and recovery phases of ICU care to help prevent cognitive decline and debility.
5. Utilize newer precision tools to rapidly identify the underlying causes, select well-targeted treatments, and boost host responses to sepsis.
6. Curtail the duration of antimicrobial treatment and avoid the use of antibiotics whenever feasible to do so.
7. Utilize modern advances in technological, molecular science, and informatics to better monitor and deliver nutritional requirements for optimized and nuanced care for the individual through all stages of critical illness.
8. Low-dose lithium may represent a viable option both to prevent AKI in patients at risk and to treat established AKI.

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