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Author (up) McKenna, H.; van der Horst, G.T.J.; Reiss, I.; Martin, D. url  doi
openurl 
  Title Clinical chronobiology: a timely consideration in critical care medicine Type Journal Article
  Year 2018 Publication Critical Care (London, England) Abbreviated Journal Crit Care  
  Volume 22 Issue 1 Pages 124  
  Keywords Human Health; Review  
  Abstract A fundamental aspect of human physiology is its cyclical nature over a 24-h period, a feature conserved across most life on Earth. Organisms compartmentalise processes with respect to time in order to promote survival, in a manner that mirrors the rotation of the planet and accompanying diurnal cycles of light and darkness. The influence of circadian rhythms can no longer be overlooked in clinical settings; this review provides intensivists with an up-to-date understanding of the burgeoning field of chronobiology, and suggests ways to incorporate these concepts into daily practice to improve patient outcomes. We outline the function of molecular clocks in remote tissues, which adjust cellular and global physiological function according to the time of day, and the potential clinical advantages to keeping in time with them. We highlight the consequences of “chronopathology”, when this harmony is lost, and the risk factors for this condition in critically ill patients. We introduce the concept of “chronofitness” as a new target in the treatment of critical illness: preserving the internal synchronisation of clocks in different tissues, as well as external synchronisation with the environment. We describe methods for monitoring circadian rhythms in a clinical setting, and how this technology may be used for identifying optimal time windows for interventions, or to alert the physician to a critical deterioration of circadian rhythmicity. We suggest a chronobiological approach to critical illness, involving multicomponent strategies to promote chronofitness (chronobundles), and further investment in the development of personalised, time-based treatment for critically ill patients.  
  Address Critical Care Unit, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. daniel.martin@ucl.ac.uk  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1364-8535 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:29747699 Approved no  
  Call Number GFZ @ kyba @ Serial 1897  
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