SOFA-2: A Commitment to Failure
The updated score is a revival of fruitless decades-old ideas. Does it have a future?
BEFORE intensive care, one organ failure was enough to cause death.
All the generations of physicians who lived before us dealt with their own impotence in the face of impending death. Hippocrates, thousands of years ago, already commended those doctors who, in acute situations, could manage the cases better than others. I like to fantasize that he was referring to us, intensivists.
Our ability to keep a patient alive despite respiratory, renal, cardiovascular failure, etc., is nothing short of a technological miracle. Will we definitely conquer death? The tech czars out there are saying yes, in a deification of technique that would have scandalized Hippocrates.
Or perhaps we’re just pushing death to the next week. The SOFA score is the result of a flare of optimism we experienced 30 years ago after arriving at a compelling, but failed, narrative. Yes, my dear Hippocrates’ successor, Medicine is built on narratives, or, better said, disease models.
The SOFA score had a living soul. A deeply ingrained narrative animated it. SOFA's soul is now dead.
Remember, we are no better than our disease models.
Know thyself, intensivist!
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