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ACC review series 2026: sepsis 1
- Managing sepsis in the era of precision medicine: a narrative review
- Ho Jin Yong, Sung Min Kim, Dohhyung Kim
- Acute Crit Care. 2026;41(2):189-200. Published online May 28, 2026
- DOI: https://doi.org/10.4266/acc.000884
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Abstract
PDF - For decades, the management of sepsis has adopted protocolized care bundles. However, the plateau in global survival rates suggests that the "one-size-fits-all" paradigm exemplified by early goal-directed therapy has reached its limits. The physiological and biological heterogeneity of sepsis necessitates a fundamental shift toward precision medicine. This review examines the transition from empirical resuscitation to individualized care across four critical domains. First, fluid strategy is evolving from aggressive loading to dynamic stewardship. Current evidence favors balanced crystalloids over saline and advocates restrictive dosing guided by dynamic responsiveness indices and venous congestion assessments to prevent iatrogenic harm. Second, hemodynamic support is shifting toward a catecholamine‑sparing strategy. To mitigate the metabolic and immunologic toxicities of high-dose norepinephrine, multimodal vasopressors, such as vasopressin and angiotensin II, are used to target specific biological phenotypes, such as high-renin states. Third, antibiotic management balances rapid administration with rigorous stewardship through pharmacokinetic optimization, including continuous infusions, diagnostic pauses for stable patients, and short-course regimens. Finally, corticosteroid therapy is moving beyond universal debate toward targeted application. Emerging data support their use in specific responder phenotypes, notably severe community-acquired pneumonia and distinct transcriptomic endotypes. In conclusion, modern critical care is moving beyond rigid protocols toward a personalized framework. By integrating bedside biomarkers and clinical phenotypes, clinicians can deliver “the right drug, at the right dose, for the right patient," thereby optimizing outcomes in sepsis and septic shock.
Review Article
- Neurosurgery
- Personalized treatment approaches in neurocritical care
- Jae Hyun Kim, Chang-Hyun Kim, Hanwool Jeon, Hyun-Chul Jung, Seungjoo Lee
- Acute Crit Care. 2026;41(1):33-46. Published online December 8, 2025
- DOI: https://doi.org/10.4266/acc.003050
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- 3 Web of Science
- 3 Crossref
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Abstract
PDF
- Acute brain injuries—including traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage—exhibit profound pathophysiological heterogeneity, yet are often managed using standardized treatment protocols. While evidence-based guidelines have improved outcomes at a population level, they frequently overlook patient-specific variations in cerebral compliance, autoregulation, and metabolic reserve. This review explores the evolving paradigm of personalized neurocritical care, which integrates dynamic multimodal monitoring, individualized intracranial pressure management strategies, and real-time physiological indices such as pressure reactivity index, cerebral perfusion pressure optimization, and waveform analytics. We highlight the role of noninvasive modalities including quantitative pupillometry, transcranial Doppler, optic nerve sheath diameter ultrasound, near-infrared spectroscopy, and electroencephalography as adjuncts when invasive monitoring is limited or contraindicated. Furthermore, we examine tissue-level monitoring using brain oxygen tension and cerebral microdialysis and emerging blood-based biomarkers such as glial fibrillary acidic protein and neurofilament light. These tools provide granular insight into evolving secondary injury processes. In parallel, advances in artificial intelligence (AI) and machine learning enable deep phenotyping, predictive modeling, and integration of high-dimensional data including imaging, physiology, and omics-based profiles. The development of digital twin models further supports individualized simulation and therapeutic planning. While challenges remain in implementation, data harmonization, and resource availability, the convergence of physiologic monitoring, molecular profiling, and computational modeling offers a transformative pathway toward precision medicine in neurocritical care.
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Citations
Citations to this article as recorded by
- Artificial Intelligence in Neuro-Ophthalmology for Optic Disc Pathologies and Neurodegenerative Disease
Abhimanyu Ahuja, Alfredo Paredes III, Mallory Eisel, Cole Miller, Nina Truong, Julie Falardeau
Eye and Brain.2026; Volume 18: 1. CrossRef - Physiology, monitoring, and optimisation of perioperative tissue oxygenation: a narrative review
Jens Meier, Sigismond Lasocki, Patrick Meybohm, Daniela Filipescu, Thorsten Haas, Julien Pottecher, Emmanuel Rineau, Stefano Romagnoli, Alina Bergholz, Bernd Saugel
British Journal of Anaesthesia.2026; 136(6): 1761. CrossRef - Risk factors and development of a prediction model for hematoma expansion in elderly patients with spontaneous intracerebral hemorrhage
Xian-Xing Yu, Zhi-Yong Ye, Guang-Hui Zhu, Zhi-Hua Zhang
Frontiers in Aging Neuroscience.2026;[Epub] CrossRef
- Artificial Intelligence in Neuro-Ophthalmology for Optic Disc Pathologies and Neurodegenerative Disease
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