First-principles critical care: Eleven core tenets

Developing a First-Principles Mindset In Critical CareClinical reasoning in critical care often begins with rapid recognition of abnormal variables and immediate intervention.However, critically ill patients usually deteriorate through tightly coupled physiological systems rather than through isolated abnormalities.In philosophy, science, physics, and engineering, a first principle refers to a basic proposition or constraint that is not derived from another proposition within the same system.Clinically, firstprinciples critical care means identifying the dominant violated physiological constraint, choosing the intervention most likely to restore it, and reassessing whether the patient is moving toward organ and cellular stability.The following eleven tenets are proposed as a novel host/organ unregulated response (HOUR)-centered synthesis of mechanistic anchors for bedside reasoning.