Critical Care at Fresenius Medical Care

Fresenius Medical Care has established critical care as a key pillar for strategic growth. To help realize the company’s long-term vision, the Global Medical Office has created an interdisciplinary critical care therapy team to guide the development new diagnostic tools, advanced data analytics and AI capabilities, innovative devices, and other critical care delivery improvements.

Critical care, or intensive care, is the medical specialty that treats life-threatening conditions, which are often accompanied by organ and/or central nervous system dysfunction. Critical illness necessitates highly complex medical care and may require the need for multi-organ support. The primary goal of critical care is to provide physiologic support while the underlying disease or injury is treated and, in that regard, may be considered by some as “bridging” rather than “healing.”

Despite significant improvements in critical care medicine over the past decades, the number and utilization of critical care beds is still on the rise.1 Multiple factors may contribute to the observed increase, including aging populations, higher prevalence of coexisting chronic illnesses, broader use of immunosuppressive therapies, higher utilization of medical procedures and devices, and the spread of multi-drug-resistant pathogens. Despite the increasing numbers of critically ill patients, the overall mortality associated with critical illness has declined—e.g., age-standardized sepsis mortality decreased by 52.8 percent from 1990 to 2017.2 This may be related to a better understanding of pathophysiology, improvements in ICU management (e.g., acute respiratory distress syndrome protocols, prevention of bloodstream infections), innovations in treatment, and advances in extracorporeal organ support.

CRITICAL CARE: STRATEGIC VISION FOR THE RENAL CARE CONTINUUM

In 2020, Fresenius Medical Care established critical care as one of three strategic pillars for the company’s successful long-term growth (Figure 1). This vision also includes the renal care continuum, the critical care space, and complementary assets — innovations that can advance the company’s work in kidney and critical care. Critical care as a core domain recognizes the importance of multi-organ support as a key component of care for those with critical illness. Today, the Fresenius Medical Care portfolio includes extracorporeal kidney, heart, and lung support. Kidney replacement therapies for acute kidney injury in the ICU include the company’s multiFiltratePRO CRRT device and the NxStage System One. Integration of the Xenios company into the Fresenius Medical Care portfolio in 2016 expanded extracorporeal support to include heart and lung therapies such as extracorporeal membrane oxygenation (ECMO) and decarboxylation (extracorporeal CO2 removal, or ECCO2R) systems. In addition to providing critical care services in selected countries, Fresenius Medical Care also provides a portfolio of critical care products throughout the world (Figure 2).

FIGURE 1  |  Critical Care is one of Fresenius Medical Care’s three strategic pillars.

FIGURE 2 | Critical Care portfolio offered by Fresenius Medical Care.

CRITICAL CARE OPPORTUNITIES

Fresenius Medical Care has identified the following opportunities to further improve critical care therapies: the development of innovative devices; automation of processes related to the function and operation of medical devices; optimization of medical device usability; access to intensive therapy expertise (e.g., continuous kidney replacement therapy, ECMO, apheresis support); expansion of ICU point-of-care testing; and enhanced clinical decision support.

To lead these efforts, the Global Medical Office at Fresenius Medical Care has established a critical care therapy team whose medical expertise spans multiple specialties including cardiac surgery, surgical and medical critical care, and anesthesiology.  With its comprehensive and diverse views on the various disease pathologies and therapeutic approaches within the ICU, the team will provide medical guidance for the development and execution of the critical care strategy and collaborate with a network of external advisors around the globe.

Initial areas of focus include the development of less invasive ECCO2R for treatment of acute exacerbation of chronic lung disease and pulsatile flow during ECMO therapy (i-COR) to support cardiogenic shock. One of the key challenges for multi-organ extracorporeal support is vascular access. Support systems that can use a single vascular access are an important area of development within the company. The critical care team plans to explore opportunities to improve diagnostic and patient surveillance at the point of care and advanced data analytics and artificial intelligence capabilities to improve medical decision making.

In summary, the development of critical care therapies will include the continuous strengthening and expansion of the company’s current extracorporeal organ support technologies and has the potential to improve critical care in communities around the world.

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References

1. Halpern NA, Goldman DA, Tan KS, Pastores SM. Trends in critical care beds and use among population groups and Medicare and Medicaid beneficiaries in the United States: 2000-2010. Crit Care Med 2016;44(8):1490-9. doi:10.1097/CCM. 0000000000001722. 
2. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020;395(10219):200-11. doi:10.1016/S0140-6736(19)32989-7.