Organ function rehabilitation in critically ill patients is fundamental to intensive care treatment, as organ dysfunction is associated with adverse outcomes. Integrating the concept of accelerated rehabilitation in the ICU, clinical treatments should aim to achieve functional recovery alongside hemodynamic stabilization, tailored to the disease type and the regulatory mechanisms of different organs' pathophysiology. Traditional shock resuscitation strategies prioritize perfusion, leaving organ function as the final consideration. The key is to focus on organ function early in the shock resuscitation process, guiding hemodynamic treatment to combine blood flow and organ function. By targeting organ function improvement through thorough assessment and precise treatment, we can achieve organ protection and long-term repair, ultimately improving the prognosis and quality of life for patients.

In May 2023, the American Society of Critical Care evaluated the neurology, peritransplant, infectious and gastrointestinal disease of acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) in ICU, integrated the latest clinical relevant studies, issued clinical management guidelines, put forward 28 recommendations and core points with clinical practice value, which has important clinical value in guiding the diagnosis and treatment practice of ALF and ACLF in ICU. By interpreting the guide, this paper encourages clinicians, especially critical care physicians, to deeply understand and apply the guide scientifically.

In managing novel coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS) patients, proper external chest-wall compression may be beneficial, making it a big challenge to rethink about traditional lung protective ventilation strategies. In recent years, many studies have shown that external chest-wall compression can improve oxygenation and respiratory mechanics in ARDS patients, but therapeutic result remains controversial. This article mainly reviews physiological effects, implementation methods and clinical applications of chest wall compression.

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by diffuse inflammatory alveolar and pulmonary capillary injury caused by both pulmonary and extrapulmonary factors. Due to the complexity of the pathogenesis and widespread heterogeneity at the cellular level, traditional sequencing techniques, which use many cells or tissues as study samples, reflect the overall transcriptomic characteristics of cells but cannot capture the diversity of cellular subgroups and individual cell heterogeneity. This limitation hinders the exploration and application of potential disease targets. Single-cell sequencing provides a new approach to investigate the unique gene expression patterns and molecular mechanisms of individual cells in ARDS. It is crucial for understanding the pathogenesis, clinical features, and identification of potential therapeutic targets in ARDS. This review offers additional insights into the application of single cell sequencing in ARDS, providing a more solid foundation for research in this field.

Monocytes/macrophages, as the first line of defense against stimuli in the lungs, play an undeniable role in mediating the occurrence and development of immune inflammatory responses in the lungs of acute respiratory distress syndrome (ARDS) through extracellular vesicle (EV). This article reviews the research progress on the mechanism of EV derived from monocytes/macrophages in ARDS and their potential clinical significance in the diagnosis and treatment of ARDS.

Acute respiratory distress syndrome (ARDS) is refractory hypoxemia characterized by diffuse alveolar injury. As a complication, pulmonary fibrosis often leads to high mortality, especially in severe COVID-19. The heterogeneity of ARDS is prominent. Current researches focus on precise treatment for subtypes of ARDS. However, mechanism of fibroproliferative ARDS is complex, lack of diagnostic biomarkers for clinical application, which increases the difficulty of treatment and predicting prognosis. This article reviews research progress of pulmonary fibrosis pathogenesis in ARDS.

Sepsis is life-threatening organ dysfunction resulting from a dysregulated host response to infection. Vascular endothelial injury is an important feature of sepsis, and inhibiting endothelial injury can help to improve organ function and prognosis in patients with sepsis. As an important carrier of intercellular communication, extracellular vesicles play an important role in vascular endothelial injury in sepsis by affecting the endothelial barrier, leukocyte adhesion, coagulation, angiogenesis and cell death. This paper summarizes the role of extracellular vesicles in vascular endothelial injury in sepsis, in order to further understand the pathogenesis of sepsis and provide new ideas for sepsis treatment.

Sepsis is the main cause of ICU admission. Sepsis originates from an infection and progresses due to host desregulated immune response, ultimately leading to deterioration in tissues and organs. The pathogenesis of sepsis is complicate, with multiple mechanisms involved in its pathological and physiological processes. The immune state of the body is significantly disrupted. Thanks to the ongoing advancements in medical technology and the increasing knowledge of sepsis by ICU physicians, sepsis patients can typically endure the initial inflammatory response. However, in the later stages, they are susceptible to secondary infections due to immune suppression, which still carries a significant risk of mortality. At present, the research on sepsis mainly focuses on immunosuppression and immunomodulatory strategies. We review the nomenclature, origin, and research progress of myeloid suppressor cells (MDSCs) in sepsis in this manuscript. It also presents the theoretical foundation for future treatments of sepsis-related immune dysfunctions.

Sepsis is a clinical syndrome with a high mortality rate, and despite the development and advancement of multidisciplinary approaches, sepsis can progress to fatal organ failure. In recent years, the rapid development of single-cell sequencing technology has provided a new technical support for the exploration of the pathophysiological mechanism of sepsis, especially the application in immunology has made the precise prevention and treatment of sepsis possible. This review reviewed relevant studies in recent years, described the occurrence and development of sepsis and sepsis-induced immunosuppression, introduced the application progress of single cell sequencing technology in sepsis and sepsis-induced immunosuppression research, and aimed to explore the possibility of future application of single cell sequencing technology in the precision treatment of sepsis.

Asymmetrical lung injury refers to the heterogeneous lung injury in the left and right lungs, which is different from the common lung injury characterized by the heterogeneity of anteroposterior gravity gradient. Asymmetrical lung injury, with its particularities in terms of pathophysiological features and respiratory mechanics, has received recent attention. This review focuses on the epidemiology, common causes, diagnosis, respiratory mechanics characteristics, application of electrical impedance tomography and therapy for asymmetric lung injury, with the hope of promoting understanding and further research into this type of lung damage and providing targeted treatment for this group of patients.

In recent years, extracorporeal membrane oxygenation (ECMO) is being widely used to treat patients with acute reversibility refractory cardiogenic shock and/or refractory respiratory failure. Despite its proven efficacy, ECMO carries significant risks for complications, and infection is one of the most common complications during ECMO support. Infections during ECMO support have significantly increased mortality of these patients. In this paper, infections during ECMO support have been reviewed for a better understanding, prevention and management.

Thyroid storm is a life-threatening condition that requires rapid diagnosis and urgent treatment, and it is a complication of Graves’ disease (GD) that is untreated or insufficiently treated. Upper gastrointestinal bleeding is the first manifestation, and there is no previous history of thyroid function, and Evans syndrome (ES) is a rare clinical complication. This paper reported a patient with thyroid storm with upper gastrointestinal hemorrhage as the first manifestation. After admission, his complication such as liver injury, acute renal failure, disturbance of consciousness, acute respiratory failure, circulatory failure, epilepsy and shock occurred. Thyroid storm was quickly diagnosed and GD was diagnosed for the first time. During the treatment with anti-thyroid drugs, there was a decrease in hemoglobin (Hb) and platelets. After relevant examinations, ES was considerd. After treatment with Glucocorticoid and intravenous Gamma globulin, Hb and platelets gradually increased. After discharge, he continued to take Thiamazole and Methylprednisolone orally, and took regular reexamination every half month. At present, his kidney function and platelets were normal, and Hb was in the rising stage. This case suggests that GD can have many different clinical manifestations, thyroid storm is extrem clinical manifestation, and the diagnosis is challenging. The combination of ES is not a coincidence, as both of them are autoimmune diseases. The treatment of Thiamazole combined with Methylprednisolone and immunoglobulin can improve the patient’s Hb and platelet and recover the condition.