Fig. 1

The four pillars of personalized physiological medicine. Pillar I is measurement of the fitness and frailty of the patient and their physiological reserve and fitness to deal with the physiological stress of critical illness. Pillar II concerns measurement of the function of organ systems and their response to therapy as well as their functional capacity and reserve including the immunological, humoral and coagulatory systems. Pillar III concerns the measurement of the hemodynamic coherence between the macro- and microcirculation and parenchymal cells in response to resuscitation. The loss of hemodynamic coherence can be identified by observation of the microcirculation, where type 1 concerns inflammation and infection-induced heterogeneous obstructions of microcirculatory flow, type 2 concerns hemodilution-induced loss of red blood cell filled capillaries, type 3 concerns microcirculatory stasis induced by excessive vasopressor load or raised venous pressures, and type 4 concerns tissue edema (red cells are well oxygenated and blue cells are hypoxic cells; taken from [35] with permission). Pillar IV is the integration and feedback of the various elements of the personalized physiological medicine modules to provide input in an integrative and time variant holistic manner to identify and assess the success of therapy and severity of organ and cellular dysfunction, as well as identifying the essential parameters in need of correction