The medical service capacity of critical care medicine，as a key line of defense for safeguarding people's lives and health，hold significant importance in their development. In 2024，the National Health Commission of China and seven other departments jointly issued the Opinion on Strengthening the Construction of Critical Care Medical Service Capacity，comprehensively promoting high - quality development by improving the critical care network，enhancing specialty capacities，expanding the talent team，and promoting medical service. This article elaborates on the key aspects of building the medical service capacity of critical care medicine. These include establishing a sound disciplinary system based on the national conditions，optimizing the service system with a focus on the primary care，intensifying talent cultivation to to solidify the foundation of capacity building，strengthening quality management to uphold the safety bottom line，and paying attention to scientific research for development to foster disciplinary development. The aim is to further promote the intrinsic development of critical care medicine，enhance service capabilities，thereby continuously supporting the implementation of the Healthy China strategy and effectively safeguarding people's lives and physical health.
Quality control is the core of ensuring patient safety in critical care medicine. In 2024，remarkable progress has been made in the quality control of critical care medicine in China. Under the guidance of policies，the indicator system has been continuously improved，and the quality control network has been continuously strengthened. By focusing on key disease and critical technologies，the goal-oriented quality improvement has been achieved through the single-disease quality control management system，standardized technical training，and scientific research. In future work，we should continue to focus on weak links，remain demand-oriented，and aim for homogenization to continuously promoting the quality control of critical care medicine to a new height.
Neurocritical care is an interdisciplinary field that integrates critical care medicine with neurology and neurosurgery. It encompasses primary neurocritical diseases or secondary neurological injuries accompanied with existing or potential organ dysfunction，requiring intensive monitoring and treatment. In 2024，numberous high-quality clinical studies emerged in the field. This article reviews and summarizes the key developments in neurocritical care in 2024.
With the development of critical care medicine and related technology，the research of critical kidney disease has been deepened. In the ICU，breakthroughs have been made in the research of critical illness-related acute kidney injury （AKI），chronic kidney disease （CKD），kidney transplantation management，difficult kidney disease and blood purification treatment. For example，intravenous amino acids are effective in preventing AKI after cardiac surgery，reducing its incidence and the need for renal-replacement therapy （RRT）. At the same time，the application of artificial intelligence technology，such as AKI early warning system combined with individualized treatment，can significantly improve the clinical outcome of patients. This article reviews the research progress and hotspots of critical kidney disease in the past year，so as to provide reference for clinical and future research.
Retrospective studies based on the new global definition of acute respiratory distress syndrome （ARDS） have elucidated the changes brought about by these new criteria from the perspective of diagnostic scope. The updated ARDS guideline from the American Thoracic Society conditionally recommend the use of glucocorticoids，providing new insights into treatment. Innovations explorations non- and invasive respiratory support strategies have demonstrated highlighted advantages in specific populations，promoting the optimization of clinical practices. The analysis of key bottlenecks in delayed weaning highlights the importance of screening，contributing to improve weaning practices. This review highlights critical scientific research advancements in the field of critical respiratory medicine in 2024.
Sepsis，as a major challenge in critical care medicine，is fundamentally characterized by dysregulated host immune response. This paper elucidates the latest research advancements from the following four perspectives：mechanisms of host immune response dysregulation，new methods for immune monitoring，precision immunotherapy strategies，and the developmental prospects of a stepwise approach to precision treatment in sepsis. This review summarizes current progress in sepsis immunotherapy，explores its challenges and opportunities，and provides new insights for precision immunotherapy in sepsis.
Sepsis-associated encephalopathy （SAE） is a common complication in critically ill patients，and its pathogenesis is complex and lacks specific treatment. In recent years，gut flora has been found to regulate neuroinflammation and blood-brain barrier function through the “gut-brain axis”，which has become a new direction for SAE intervention. In this paper，we review the role of gut dysbiosis in SAE，explore the therapeutic strategies of probiotics，fecal transplants，and targeting of bacterial metabolites and signaling pathways，and future research should integrate multi-omics techniques with clinical translational validation.
The explosive growth of artificial intelligence （AI） technology has brought revolutionary opportunities to critical care medicine. This study systematically explores the key applications of AI in critical care informatization，including intelligent electronic medical record （EMR） analysis，multimodal data integration，AI-assisted clinical decision-making，optimization of tele-intensive care unit （Tele-ICU），and the synergistic integration of emerging technologies such as the Internet of Things （IoT），blockchain，and virtual reality/augmented reality （VR/AR）. By analyzing current AI-driven practices in critical care，this research highlights its core value in enhancing diagnostic precision，optimizing resource allocation，and reducing healthcare costs. Furthermore，the study delves into the challenges hindering AI adoption，such as insufficient data standardization，model explainability gaps，privacy security risks，and limitations in clinical adaptability. It proposes breakthrough solutions through federated learning，explainable AI （ⅩAI） techniques，policy refinement，and interdisciplinary collaboration. The study also envisions future directions，including deep integration of AI with bedside terminals，construction of a lifecycle monitoring system，and innovation in precision medicine paradigms. The primary objective of this research is to provide theoretical and practical guidance for the intelligent transformation of critical care medicine，facilitating the evolution of AI from an auxiliary tool to a core decision-making engine. Ultimately，this aims to achieve comprehensive improvements in the quality and efficiency of critical care，promote equitable access to medical resources，and enhance patient outcomes.
Over the past 20 years，extracorporeal membrane oxygenation （ECMO） technology has seen rapid development in China，marked by a significant increase in the number of ECMO centers and annual operations. However，the mortality rate among ECMO-supported patients in China remains higher than the international average. To further standardize adult ECMO technical operation and promote the highquality development of ECMO technology in China，the China-Japan Friendship Hospital-National Center for Respiratory Medicine has spearheaded the integration of domestic experts in related fields to formulate the Practice Standards for Adult Extracorporeal Membrane Oxygenation Technology （2024 Edition） （hereinafter referred to as thePractice Standard）. ThePractice Standard establishes criteria and clarifies key points for the clinical operation and management of ECMO. Additionally，it provides a framework for the management of the ECMO industry. The formulation and dissemination of thePractice Standard aim to enhance the standardization and homogenization of the clinical application of ECMO technology in China. This initiative will not only improve medical quality and safety but also have profound implications for advancing the highquality development of the discipline. The purpose of this paper is to provide a systematic interpretation of the standard from the perspectives of technical background，core contents of the standard，clinical practice implications，and future development directions. By analyzing the current challenges and opportunities in the application of ECMO technology，it highlights the critical role of standard development in enhancing medical quality，ensuring patient safety，and promoting disciplinary advancements，ultimately offering reference evidence for clinicians and researchers.
In 2024，the National Health Commission formulated and officially implemented the Practice Standards for Adult Extracorporeal Membrane Oxygenation Technology （2024 Edition），providing important guidance for clinical ECMO-related procedures. This article，written by the contributors involved in the development of these standards，interprets the indications and contraindications of ECMO，aiming to enhance understanding and improve clinical applicability.
In recent years，extracorporeal membrane oxygenation （ECMO） has been increasingly used in clinical practice as a critical advanced life support modality for critically ill patients with acute respiratory/circulatory failure. These patients often develop complications such as acute kidney injury（AKI） and volume overload，necessitating renal replacement therapy （RRT）. The indications and optimal timing for initiating continuous renal replacement therapy （CRRT） should be determined through individualized assessment based on the patient's volume status and severity of AKI-related metabolic disturbances. In ECMO patients，CRRT can be connected to ECMO in various ways，and there is currently no evidence to suggest different methods of combining ECMO and CRRT affect clinical outcomes. The combined use of ECMO and CRRT is a safe and effective technique to improve fluid balance and stabilize the internal environment. We focus on interpreting key clinical issues that addressed in thePractice Standards for Adult Extracorporeal Membrane Oxygenation Technology （2024 Edition），including indications，timing，connection methods，prognosis and risk factors associated with ECMO-CRRT combined therapy.
Thrombosis and bleeding are common complications in patients undergoing extracorporeal membrane oxygenation （ECMO）. Balancing the risks of thrombosis and bleeding remains a significant challenge. To guide the practice of ECMO anticoagulation，we have focused on interpreting the norms of ECMO anticoagulation management based on the Practice Standards for Adult Extracorporeal Membrane Oxygenation Technology （2024 Edition）. We comprehensively introduce the anticoagulants frequently employed in ECMO management，including their mechanisms of action，monitoring methods，advantages，and limitations. Additionally，it outlines the current indices for anticoagulant monitoring，objectives for anticoagulation therapy，and the merits and demerits of various monitoring approaches.
National Health Commission （NHC） first issued the Practice Standards for Adult Extracorporeal Membrane Oxygenation Technology （2024 Edition），which covers the indications/contraindications，related operations and management of ECMO technology，aiming to standardize its application. We mainly interpret the part of weaning from ECMO in this specification，aiming to enhance understanding and improve the feasibility and compliance of its clinical application.
To summarize the single-center experience，clarify its clinical prognosis and complications of piatients who received prolonged ECMO，and propose management strategies.
Methods
The date of 17 critically ill patients who received prolonged ECMO （≥14 days） life support in ICU of Peking Union Medical College Hospital from 2020 to 2023 were retrospectively analyzed，including their treatment strategies，ECMO-related complications，comorbidities，and survival prognosis.
Results
Of the 17 patients，14 received VV-ECMO and 3 received VA-ECMO. The Long-ECMO（Etiology-Coagulation-Multidisciplinary-Organ） management strategy was applied. The duration of ECMO support was 29 （24，34） days，with the longest duration being 88 days. Eleven patients received vasoactive drugs simultaneously，7 patients received CVVH treatment，and all 17 patients exhibited hemorrhagic complications，including 15 patients presenting with local hemorrhages at the ECMO catheterization site，3 patients developing thigh hematoma，13 patients experiencing nasal cavity bleeding，3 patients manifesting airway hemorrhages，2 patients with intracranial hemorrhages，and 3 patients displaying gastrointestinal bleeding. Five patients had positive blood cultures，and 4 patients had pneumothorax. Nine patients （52.9%） successfully withdrew from ECMO，and 8 patients survived during hospitalization （47.1%）.In the subgroup of 14 VV-ECMO patients，there was no difference in the ECMO support time and age between the survival group （7 cases） and the non-survival group （7 cases） ［ECMO support time：（29.0±11.2） days vs（33.9±24.9） days，P=0.647； age：（65.6±6.9） years vs （69.6±14.5） years，P=0.522］. However，the baseline APACHE Ⅱ score in the non-survival group was significantly higher with statistically significant difference［（26.3±9.2） scores vs （14.6±1.9） scores，P=0.006］.
Conclusions
The prolonged ECMO management strategy can save the lives of critically ill patients. Attention should be paid to the prevention and treatment of complications and organ repair，and it also has certain application value in elderly patients.
To evaluate the impact of an ARDS management system，which is based on a smart ICU platform，on the clinical outcome of ARDS.
Methods
This study retrospectively analyzed the clinical data of 145 ARDS patients admitted to the Department of Critical Care Medicine of the Second Ⅹiangya Hospital of Central South University from 23 December，2023 to 31 July，2024，who were divided into a control group （67 cases，ARDS patients admitted to the ICU from 23 December，2023 to 11 April，2024） and a smart system group（78 cases，after the launch of the smart ICU cloud platform from April 12，2024 to July 31，2024） according to whether they used a smart management system intervention. Baseline data ［including gender，age，underlying disease，ARDS etiology，acute physiology and chronic health status evaluation （APACHE Ⅱ） score，sequential organ failure assessment （SOFA） score，oxygenation index （PaO2/FiO2）］，outcome measures （including invasive mechanical ventilation，hospital stay，ICU stay，mortality），mean of the first 3 days and Vt changes （including PaO2/FiO2，SpO2/FiO2，PA-aO2，Vt）.
Results
There were no significant differences in gender，age，underlying disease，causes of ARDS，APACHE Ⅱ score，SOFA score，PaO2/FiO2，Vt between the control and smart system groups. In comparison to the control group，patients in the smart system group exhibited a significantly reduction in invasive mechanical ventilation times （P=0.006）； patients in the smart system group also exhibited reduced rate of tracheotomy，hospital stays，ICU stays，and lower treatment costs，though these differences were not statistically significant （P＞0.05）. The mean PaO2/FiO2，SpO2/FiO2，PA-aO2 in the first 3 days of group 2 improved significantly compared with the first day （P＜0.05）.
Conclusion
The implementation of a smart platform for the management of ARDS may shorten the duration of invasive mechanical ventilation.
Oxazolidinones are a novel class of fully synthetic antibiotics that have shown activity against multi-drug resistant Gram-positive bacteria and Mycobacterium tuberculosis. Contezolid is a novel Oxazolidinone with potent activity against Methicillin-sensitive Staphylococcusaureus （MSSA），Methicillinresistant Staphylococcus aureus （MRSA），Streptococci and Enterococci. Compared to Linezolid，Contezolid is associated with a lower risk of causing thrombocytopenia. This paper reviews the chemical properties，usage and dosage of the approved indications，pharmacological activity，antibacterial activity，safety，and clinical application and research progress，providing a reference for its clinical rational application and future research.
Protective ventilation strategy can reduce ventilator induced lung injury in mechanically ventilated patients with acute respiratory distress syndrome （ARDS）. Traditional lung protective ventilation strategy lacks evaluation of respiratory drive and neglects diaphragm protection. Some patients with poorly controlled respiratory drive are at risk of lung injury and diaphragmatic injury，even with lung protective ventilation strategy. This article reviews the research progress in respiratory drive in protective ventilation strategy.
Non-occlusive mesenteric ischemia is characterized by ischemic injury or necrosis of the intestine stemming from non-obstructive causes. One of the major risk factors for non-occlusive mesenteric ischemia in shock patients is the decrease in blood volume within the circulatory system. Early enteral nutrition during shock may exacerbate the imbalance between the oxygen supply and demand of the intestines，thus facilitating the development of non-occlusive mesenteric ischemia. Nevertheless，diagnosing non-occlusive mesenteric ischemia in critically sick patients is typically challenging，as it is linked to a significant risk of death. This paper will review the advancements on the risks and preventive measures of non-occlusive mesenteric ischemia induced by early enteral nutrition in shock states，which aim to provide support for improving the prognosis of non-occlusive mesenteric ischemia.
Fluid resuscitation plays an important role in the treatment of septic shock. For adults with sepsis or septic shock，crystalloid is recommended as first-line fluid for resuscitation in the latest Surviving Sepsis Campaign guidelines. The specific type of crystalloid given is still controversial. Saline is prone to hyperchloremia due to high chloride concentration and has adverse effects on the renal function. Balanced crystalloids are of interest to clinicians because their composition are closer to extracellular fluid of human body. In this paper，the advantages and disadvantages of different crystalloids and their selection were summarized based on the research of the influence of crystalloids on acute kidney injury in patients with septic shock in recent years.
