Since 2017, foundational data has been solidified through nationwide surveys on ECMO resource allocation, providing critical support for policy formulation. Standardized training systems have been established alongside clinical consensus guidelines, facilitating the transformation of individual expertise into industry standards. A cross-institutional collaboration network has been built to drive synergistic innovation in device miniaturization, data-driven decision-making, and systematic care delivery. The development of extracorporeal life support emphasizes both multidisciplinary collaboration and medical ethics. Our overarching goal is to evolve from simply prolonging survival through isolated technologies to a paradigm of holistic health management that improves quality of life. This will be achieved by fostering conceptual innovation and driving R&D to build optimized regional healthcare networks and elevate patient management standards, all guided by our core strategy of "Founding Mission as the Helm, Innovation as the Sail." By reviewing a series of extracorporeal life support core work in China, including national surveys and standardized training, this article aims to clarify that the original aspiration of medicine carries the dual responsibilities of clinical and technical dissemination, thereby charting an innovation-driven course for future development.

In 2025, clinical research in extracorporeal life support (ECLS) has further advanced the precision and individualized application of cardiac and respiratory support strategies. In the field of cardiac support, identification of patients most likely to benefit from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) increasingly relies on comprehensive assessment using multiple hemodynamic parameters, while bundled management strategies incorporating standardized physiological targets have shown clinical outcomes. The recommendation level for microaxial flow pumps in patients with ST-segment elevation myocardial infarction (STEMI) complicated by severe cardiogenic shock has been upgraded. In addition, extracorporeal cardiopulmonary resuscitation (ECPR) emphasizes rapid deployment and precise patient selection. In terms of respiratory support, the indications for veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe trauma, lung transplantation bridging and other clinical settings have been further clarified. Prone positioning during ECMO support has been shown to reduce mortality in selected patients with acute respiratory distress syndrome (ARDS), although attention to complications such as thrombocytopenia remains essential. Furthermore, standardized weaning protocols may help shorten ECMO duration. Artificial intelligence also contributes to more precise ECMO management. In summary, advances in ECLS research in 2025 underscore the growing emphasis on precision medicine and individualized management, while highlighting the need for further clinical investigations to optimize patient selection and improve prognosis. This article reviews the latest clinical research findings in the field of ECLS for the year 2025, providing up-to-date evidence-based medical evidence for clinical practice.

In recent years, a major challenge in sepsis immunotherapy has been the marked heterogeneity of host immune responses. Addressing this issue, numerous studies published in 2025 have advanced the understanding of immune phenotyping and the development of precision immunotherapeutic strategies. This review systematically summarizes both domestic and international research on precision immunotherapy in sepsis, highlighting current approaches, key findings, and emerging trends. In addition, it critically examines the challenges, limitations, and potential opportunities in the field, providing insights to guide future research and clinical application of individualized immunotherapy for sepsis.

Neurocritical care is an interdisciplinary specialty integrating critical care medicine, neurology, and neurosurgery, focused on the comprehensive monitoring and management of patients with acute brain injury. This review summarizes major advances in neurocritical care reported in 2025. Recent progress in the management of ischemic stroke, hemorrhagic stroke, and traumatic brain injury (TBI) has further clarified the roles of endovascular therapy, transfusion strategies, and other targeted interventions in clinical practice. The introduction of MK 4.0 represents a paradigm shift in the understanding and management of intracranial pressure, while the B-ICONIC consensus has provided structured recommendations for the clinical application of noninvasive intracranial pressure monitoring. In addition, the development of a multidimensional assessment framework for TBI, the publication of a consensus statement on acute severe encephalopathy, and the proposal of a six-step roadmap for disorders of consciousness (DoC) have further refined current diagnostic and therapeutic pathways. Collectively, these advances reflect an ongoing transition toward greater standardization, precision, and individualized management in neurocritical care, with important implications for improving outcomes and guiding future research in acute brain injury.

International evidence has demonstrated that early adequate anticoagulation improves survival in patients with acute mesenteric ischemia without increasing the risk of bleeding complications. Artificial intelligence-assisted automated bedside assessment of gastric motility assessment has emerged as a novel approach for individualized nutritional support in critically ill patients. Recent large-scale clinical trials have questioned the routine use of high-protein nutrition and probiotic/prebiotic supplementation in critical illness, highlighting the context-dependent efficacy of these interventions. Moreover, advances in understanding the gut-lung axis and the association between gut microbiota resistome profiles and patient prognosis have provided novel perspectives for infection prevention and management. Studies investigating stress ulcer prophylaxis, particularly through analyses of treatment-effect heterogeneity, have further advanced the concept of precision prevention. In addition, optimized transfusion strategies for thrombocytopenia-associated gastrointestinal bleeding in critically ill patients have been proposed. Although several of these findings still require further validation, collectively they provide a solid foundation for the development of individualized therapeutic strategies based on deeper pathophysiological understanding and emerging technologies. This review summarizes and critically appraises major advances in critical care gastroenterology reported in 2025.

Critical care nephrology is evolving from a discipline focused primarily on acute organ support toward an integrated framework encompassing mechanistic insights, precision-based clinical decision-making, and long-term risk management. Advances reported in 2025 have further expanded the understanding of acute kidney injury (AKI) pathogenesis, with metabolic reprogramming, ferroptosis, epigenetic regulation, and immune-inflammatory networks emerging as major research priorities and potential therapeutic targets. Clinical management is becoming increasingly individualized and precise. AKI subphenotyping is facilitating stratified therapeutic strategies, while decisions regarding the initiation of continuous renal replacement therapy (CRRT) are shifting toward more cautious and patient-specific approaches. Fluid management strategies are being refined through the integration of artificial intelligence and the concept of hemodynamic coupling. In addition, management of cardiorenal syndrome (CRS) increasingly emphasizes multi-organ coordination and the application of novel therapeutic agents. Long-term follow-up studies have confirmed that AKI is a significant risk factor for chronic kidney disease (CKD) progression, leading to broad recognition of the "AKI-to-CKD continuum" as a key concept in patient management. Future progress in critical care nephrology will depend on the translation of mechanistic discoveries into clinical practice, validation through multicenter randomized controlled trials, and the establishment of multidisciplinary, continuum-of-care models. This paper provides a systematic review of related research to offer reference for future research directions and clinical practice.

Severe acute pancreatitis (SAP) is characterized by sudden onset, rapid progression, and high mortality, demonstrating marked time-dependence in its treatment. This article explores the application and significance of the "First-aid Philosophy" emphasizing "Early, Accurate, and Decisive" in the management of SAP. This article focuses on how this concept systematically optimizes SAP treatments [time-window-based goal management (e.g., early fluid resuscitation within 24 hours, early enteral nutrition), damage control strategies (e.g., avoiding early overly invasive interventions), synergy between causative and supportive treatments, and consistent multi-disciplinary therapy (MDT)] throughout patients' care. The core significance lies in integrating this proactive and decisive emergency mindset into practice to effectively block the progression of SAP, and ultimately to improve patients' prognosis.

To evaluate the impact of laparoscopic retroperitoneal pancreatic necrosectomy (LPRN) on 90-day mortality and 30-day postoperative bleeding in IPN patients.

A single-center retrospective cohort study included 87 IPN patients who were admitted to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2013 to December 2020. Patients were divided into the LPRN group (n=65) and the open surgery group (n=22). Kaplan-Meier survival analysis, multivariate Cox regression, and Logistic regression were used to assess the impact of LPRN on patient outcomes.

The 90-day mortality rate was significantly lower in the LPRN group compared to the open surgery group (12.31% vs 45.45%, P＜0.001), and the incidence of postoperative bleeding within 30 days was also significantly reduced (15.38% vs 40.91%, P=0.012). Multivariate regression analysis showed that LPRN significantly reduced the 90-day mortality risk (HR=0.13, 95% CI: 0.02-0.55) and the risk of 30-day postoperative bleeding (OR=0.24, 95% CI: 0.07-0.74). E-value analysis indicated the robustness of these results to potential unmeasured confounding. Subgroup analysis further confirmed that the trend towards improved outcomes associated with LPRN remained consistent across stratifications based on etiology, hematocrit, sequential organ failure assessment (SOFA) score, American Society of Anesthesiologists (ASA) classification, and the presence of preoperative septic shock.

LPRN may be associated with improved short-term outcomes in patients with infected pancreatic necrosis (IPN), though this requires further validation through prospective studies. Clinical decision-making should be based on individual patient factors, and the long-term efficacy as well as the applicable scope of LPRN need to be further investigated.

To explore the correlation between the red blood cell distribution width (RDW)-to-albumin (ALB) ratio (RAR) on the first day of intensive care unit (ICU) admission and the in-hospital mortality risk in patients with acute pancreatitis (AP), as well as its potential prognostic value.

We retrospectively analyzed data from adult AP patients, aged ≥18 years, who were admitted to the ICU for the first time between January 2008 and December 2019 in the MIMIC-Ⅳ database. Only patients who had complete RDW and ALB measurements within the first 24 hours of ICU admission, and who did not have cirrhosis or nephrotic syndrome, were included. First-day vital signs, severity scores, and laboratory data were extracted, and the RAR was calculated as RDW/ALB. Multiple imputation and complete case analysis were used to handle missing values. Multivariate Logistic regression was used to assess the independent association between RAR and in-hospital mortality, and generalized additive models (GAM) and piecewise regression were applied to explore the nonlinear dose-response relationship.

A total of 613 AP patients were included, with 333 males (54.3%) and an average age of (58.9±17.7) years. 89 patients (14.5%) died in the hospital. Univariate analysis showed a significant correlation between RAR and mortality risk (P＜0.001). Multivariate Logistic regression revealed that for each 1 unit increase in RAR, the mortality risk increased by 45% (OR=1.45, 95% CI: 1.24-1.68, P＜0.001). In unadjusted models, patients with a RAR≥5 had a 4.01-fold higher risk of death compared to those with RAR＜5, which was reduced to 3.31-fold after adjustment for APS Ⅲ, SAPS Ⅱ, SOFA, and hemoglobin (all P＜0.001). The GAM indicated a nonlinear relationship between RAR and mortality, and piecewise regression identified a threshold at 8.34; on the left side of the threshold, each 1 unit increase in RAR was associated with a 66% increase in in-hospital mortality risk (OR=1.66, 95% CI: 1.33-2.07, P＜0.001), while no significant correlation was found on the right side (P=0.229).

In ICU patients with AP, RAR is independently associated with the in-hospital mortality risk in a nonlinear fashion, and it may be an effective tool for early risk stratification.

Successful cardiopulmonary resuscitation extends beyond the restoration of spontaneous circulation (ROSC), its ultimate goal is the preservation and recovery of neurological function. However, the overall benefit of hypothermia therapy following cardiopulmonary resuscitation remains uncertain, largely due to substantial patient heterogeneity. Consequently, targeted temperature management (TTM) may not be universally applicable to all patients achieving ROSC. Appropriate patient selection is therefore critical to optimizing the therapeutic efficacy of TTM, while careful prevention and management of treatment-related complications are equally important during temperature modulation. Precision temperature management guided by multimodal neurological monitoring may improve neurological outcomes and overall prognosis in selected ROSC patients. Nevertheless, the optimal implementation strategy for TTM following cardiac arrest continues to require further clinical investigation, refinement, and validation.

Brain injury after cardiac arrest is one of the leading causes of morbidity and mortality, and effective neuroprotective strategies continue to represent a significant therapeutic challenge. Previous studies evaluating hypothermic targeted temperature management (TTM) have yielded inconsistent results. However, methodological limitations and selection bias in earlier trials may have reduced the generalizability of their findings. More recent evidence suggests that selected patients, particularly those with moderate hypoxic-ischemic brain injury, may derive benefit from hypothermic TTM, highlighting the importance of early identification of appropriate candidates. In addition, abandonment of hypothermic TTM may increase the incidence of post-resuscitation fever, which is associated with higher mortality and worse neurological outcomes. Therefore, individualized temperature management strategies based on patient characteristics and neurological status may be essential for optimizing outcomes after cardiac arrest. Therefore, the current trend advocates for an individualized strategy: selecting the target temperature based on the severity of neurological injury, initial cardiac rhythm, biomarkers, and electroencephalography, while emphasizing standardized implementation. In summary, the key to achieving benefit from hypothermic therapy lies in accurately identifying the beneficiary population and optimizing the quality of temperature management.

Targeted temperature management (TTM) refers to the controlled reduction of core body temperature to a predefined target in order to attenuate tissue injury caused by inadequate tissue perfusion and ischemia-reperfusion damage. TTM has long been regarded as a cornerstone of post-cardiac arrest care and remains the only guideline-recommended neuroprotective strategy for comatose patients after return of spontaneous circulation (ROSC). However, an increasing number of recently published trials showed that lower-temperature TTM does not confer additional benefits in neurological outcomes or survival compared with targeted normothermia. These findings have prompted ongoing debate regarding the optimal temperature target, patient selection, and implementation strategies for post-resuscitation temperature management. This article reviews and discusses current evidence and emerging perspectives related to TTM after cardiac arrest.

This article systematically explores the development and practical implementation of a humanistic and ideological-political education system for Critical Care Medicine Residents. Based on the concept of whole-person education, situated learning theory and transformational learning theory, a three-dimensional humanistic, ideological and political education framework of "goals-field-mechanism" is constructed, focusing on the organic integration of humanistic literacy and professional ability, based on the professional characteristics and practical situation of critical care medicine, and based on the "Whole-multi-dimensional-collaborative" integrated education network, this paper puts forward some suggestions on how to improve the quality of medical education, systematically construct a three-layer and six-dimensional humanistic ideological and political education system of "Value guidance-ability integration-physical and mental support". The practice results show that the constructed humanistic ideological and political education system has achieved certain results in improving the satisfaction of Critical Care Medicine residents, professional knowledge and skills, clinical practice performance and comprehensive education effectiveness, it provides theoretical and practical reference for other colleges to carry out humanistic ideological and political education. Future efforts should further integrate digital and intelligent educational technologies, strengthen evidence-based evaluation methods, and promote the transition of educational models from experience-driven approaches toward evidence-driven optimization.

To address the prominent issues in graduate education in critical care medicine, such as insufficient teaching resources and the disconnection between theory and practice, this study explores an innovative teaching approach based on artificial intelligence (AI) to enhance graduate students' clinical reasoning and emergency response capabilities.

A research team was established at the Department of Critical Care Medicine, Tianjin Medical University General Hospital. Fifty real and typical clinical cases from 2019 to 2023, covering all core diseases in critical care medicine, were selected. After double-blind desensitization, these cases were transformed into teaching cases suitable for graduate training using AI and classified into three difficulty levels: elementary (basic cases), intermediate (multidisciplinary collaborative cases), and advanced (difficult/technologically innovative cases). A knowledge graph was constructed to enable dynamic case generation and personalized case recommendations, and an intelligent teaching platform was built, integrating functions such as pre-test-based stratified learning, virtual emergency scenario simulation, and mind mapping for comparing with expert decision-making. A three-stage teaching process of "pre-class preparation—in-class simulation—post-class reflection" was adopted. Thirty-three graduate students majoring in critical care medicine from the 2022–2024 cohorts of Tianjin Medical University were selected as the experimental group (using the intelligent platform + novel teaching model), and 34 graduate students of the same major from the 2021–2023 cohorts served as the control group (adopting the traditional teaching model). There were no statistically significant differences in baseline data between the two groups (P＞0.05), indicating comparability. The observation indicators included the scores of case analysis questions in the final examination, and the results of a questionnaire survey on students' satisfaction with the teaching model and evaluation of ability improvement.

The average score of the experimental group on case analysis questions was 75.94, which was significantly higher than that of the control group (65.64), with an improvement of 10.3 points. The questionnaire survey results showed that 81.8% (27/33) of the experimental group students believed the model facilitated the deepening of theoretical understanding and application, 90.9% (30/33) reported enhanced clinical decision-making and emergency response capabilities, 87.9% thought it helped improve medical humanistic literacy, and 87.9% expressed willingness to continue using the platform for self-directed learning.

Through systematic case design, hierarchical adaptive teaching, personalized case recommendations, and a three-stage teaching process, the AI-based intelligent case platform can significantly improve critical care medicine graduate students' clinical case analysis ability, clinical decision-making, and emergency response capabilities. Widely recognized by students, it provides an effective new teaching paradigm for graduate education in critical care medicine and has the potential to be promoted to other clinical disciplines.

To explore the effect of a virtual simulation system combined with case-based learning (CBL) in extracorporeal membrane oxygenation (ECMO) nursing training.

Using convenience sampling, a total of 55 ICU nurses from a tertiary hospital in Shandong Province between March and June 2024 were included. They were divided into an experimental group (27 cases, 1 person withdraw, leaving 26 people remaining) and a control group (28 cases, 2 persons withdraw, leaving 26 people remaining) by random number table method. The experimental group received nurse training using the virtual simulation system of ECMO combined with CBL, while the control group received traditional training. Theoretical knowledge scores, general self-efficacy scale (GSES) and nurses clinical reasoning scale (NCRS) were compared between the two groups before and after the intervention. The system satisfaction of the experimental group was evaluated post-intervention.

After the intervention, the theoretical knowledge score in the experimental group was (81.35±5.62), which was higher than that in the control group (76.04±6.10). The GSES score in the experimental group was (3.14±0.51), which was higher than that in the control group (2.71±0.40). The NCRS score in the experimental group [(61.96±5.14) scores] was higher than that in the control group [(56.03±4.21) scores], and the differences were statistically significant (P＜0.05). Nurses in the experimental group were highly satisfied with all system dimensions, and the overall scores were (35.23±2.01) points.

The virtual simulation system of ECMO combined with CBL in nursing training was highly satisfactory. It improved the knowledge level, self-efficacy, and clinical reasoning ability of nurses and enriched a high-quality information-based training method.

Sepsis is a common and critical illness in the intensive care unit (ICU) with high mortality, and remains a major challenge in clinical practice. Hemoperfusion, a blood purification method based on adsorption that removes either endogenous or exogenous toxins and pathogens, has attracted more and more interest for its therapeutic possibilities in the management of sepsis. This paper summarizes the mechanism and current application of hemoperfusion in sepsis treatment, with a particular focus on the timing of treatment. Early initiation and relatively prolonged continuous hemoperfusion may be quite helpful for individuals with moderate to severe sepsis requiring vasopressors.

Sepsis is a life-threatening clinical syndrome characterized by dysregulated host responses to infection, resulting in severe organ dysfunction. Although early and appropriate antimicrobial therapy remains the cornerstone of sepsis management, conventional diagnostic methods often fail to meet the clinical requirements for accuracy and timeliness in pathogen identification. Recent breakthroughs in pathogen identification through differential host immune responses offer a promising framework for a new diagnostic and therapeutic paradigm. This review summarizes progress in host-response-oriented pathogen identification, aiming to provide clinicians with innovative strategies for early, precise formulation of anti-infective regimens.

Acute respiratory distress syndrome (ARDS) is a severe clinical syndrome characterized by dysregulated inflammatory response caused by intrapulmonary and extrapulmonary injuries, and remains associated with high morbidity and mortality worldwide. Despite substantial advances in supportive care, the underlying pathogenesis of ARDS has not yet been fully elucidated. Emerging evidence suggests that epigenetic regulation plays a pivotal role in the development and progression of ARDS by modulating gene expression in response to environmental and inflammatory stimuli. Major epigenetic mechanisms include DNA methylation, histone modification and non-coding RNA-mediated regulation. As epigenetic alterations represent the interface between genetic susceptibility and environmental exposure, they may provide important insights into the heterogeneity and dynamic progression of ARDS. In this review, we summarize findings from in vitro studies, animal studies, and clinical studies to elucidate the role of epigenetic modifications in ARDS pathogenesis. Furthermore, we discuss the potential of epigenetic mechanisms as novel therapeutic targets and future directions for precision treatment strategies in ARDS.

Perioperative refractory ventricular fibrillation (RVF) refers to ventricular fibrillation that persists after standard cardiopulmonary resuscitation and multiple defibrillations, occurring within the high-risk window from the start of surgery to 24 hours postoperatively. The mortality rate is extremely high (85%-97%) and the rate of survival with intact neurological function is very low (only 5.6%). Currently, the specific epidemiological data for this condition is still lacking. As a manifestation of perioperative cardiac arrest, its incidence is (4.3-5.8) per 10, 000 cases, with significantly increased risk in emergency surgeries, infants, and elderly patients. The main risk factors include coronary artery abnormalities, concomitant heart failure or respiratory failure, and reperfusion injury related to cardiac surgery. The pathophysiological mechanism involves the synergistic effects of myocardial electrophysiological disorders, metabolic imbalance, and sympathetic storm. The key to prevention and treatment lies in implementing a stepwise intervention approach and initiating a rapid multidisciplinary collaboration process, including: promptly initiating high-quality mechanical CPR combined with dual sequential defibrillation (DSED), early identification of pulseless electrical activity (PEA) as a critical decision-making node for resuscitation; rational use of anti-arrhythmic drugs; early initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support, and transfer to the hybrid operating room for coronary angiography/percutaneous coronary intervention (PCI), etc. This review systematically elaborates on the definition, epidemiological characteristics, risk factors, pathophysiological mechanism, current treatment principles, and research progress of perioperative RVF, aiming to provide a theoretical references for clinical practice.

This article summarizes the application of objective assessment-guided precision analgesia and sedation in a patient with severe ARDS. The main nursing interventions included: accurate assessment-based analgesic therapy; neuromuscular transmission (NMT) monitoring to quantify muscle relaxation; bispectral index (BIS) monitoring to precisely adjust the depth of sedation; and progressive rehabilitation exercise. After active treatment and meticulous nursing care, the patient improved and was discharged after 21 days of hospitalization.