Developments to monitor the exhalome in organ failure in critically ill patients-a look into the future.

Critically ill patients typically need some kind of functional organ support or replacement. Cardiopulmonary and renal replacement therapies are well established measures in intensive care units. However, there are also inherent risks associated with these treatments. The appropriate and timely commencement, maintenance and termination of organ replacement procedures currently use weak surrogates as decision support in clinical practice. A more reasonable application of extracorporeal organ support can be expected to potentially lower adverse events and save costs in healthcare systems, if a precise online monitoring was available. The analysis of the exhalome offers great opportunities to detect circulatory, pulmonary, and renal failure in critically ill patients. Volatile organic compounds and exhalation patterns are associated with a series of metabolic disorders and may be key to indicate the appropriate time point for initiation, maintenance and termination of organ support technologies. It may thus be expected that mortality, infection risk, replacement therapy days, and medical costs of intensive care treatment may possibly be reduced using exhalome analysis for control of organ replacement therapies in the distant future.