Sepsis is often accompanied by complex coagulation dysfunction，particularly disseminated intravascular coagulation （DIC），which significantly exacerbates disease severity and increases mortality.Despite advances in therapeutic approaches in recent years，sepsis-induced coagulopathy （SIC） remains a significant clinical challenge.Recent studies have elucidated the underlying mechanisms of SIC and identified novel therapeutic targets，providing potential treatment strategies for clinical practice.We summarize the latest research progress in SIC dysfunction，analyze current treatment trends，and explore future research directions.
Sepsis poses a serious threat to human health，but due to the unclear pathogenesis of sepsis，there is currently no universally recognized effective treatment drug.Recently，a large number of studies have revealed that neuroimmune interactions play an important role in the occurrence and development of sepsis，closely related to multi-organ injury in sepsis，suggesting that neuroimmunity can provide effective therapeutic targets for improving organ function in sepsis.This article briefly describes the neuroimmune interactions and potential neuroimmune regulatory targets during organ injury in sepsis.
Respiratory support technology is a key component of the life support system in critical care medicine.In recent years，with a deep understanding of respiratory pathophysiology and technology advancements，the development of respiratory support technologies has focused on “providing adequate gas exchange while minimizing ventilator-associated lung injury”.Look at 2024，significant progress has been made in optimizing non-invasive ventilation comfort，early warning of non-invasive ventilation failure，respiratory drive monitoring，prevention of ventilator-associated lung injury，positive end-expiratory pressure titration，awake prone positioning，and extracorporeal respiratory support technologies.In the future，with the development of artificial intelligence，AI-guided personalized respiratory support may become an important direction for further development.
This article reviews the key research advances in the field of extracorporeal life support in 2024，with a primary focus on patient selection，optimization of management strategies，complication prevention，and technological innovation across multiple dimensions.Numerous research findings have provided clinical practitioners with more precise and cautious guidance for treatment decision-making，while also pointing to new directions for future studies in personalized therapy，multidisciplinary collaboration，and technological innovation.
In December 2022，the National Health Commission issued the Evaluation Standards for tertiary Hospitals （2022 Edition） and its implementation rules，guiding hospitals to achieve three transformations and three improvements through the evaluation of grade hospitals.The department of critical care medicine is the platform of the hospital specialty construction，and is one of the key contents of the 2022 version of the grade hospital evaluation standards.This paper first introduce the critical role of department of critical care medicine in the 2022 hospital evaluation，and analyzes three major direction，emphasis on quality，discipline and technology.Finally，it proposes strategic recommendations for promoting the high-quality development of the ICU through evaluation-driven construction，focusing on talent team building，technical project development，and quality and safety management.
Critical care medicine is a multidisciplinary and interprofessional specialty committed to the comprehensive management of patients with or at risk of developing acute，life-threatening organ dysfunction.Over the years，the field has faced the significant challenge of the heterogeneity of various critical syndromes，which has led to repeated setbacks in randomized controlled trials in the study of related diseases，making it difficult to identify effective treatments through population-based efficacy exploration.This review explores how the deep integration of multi-omics data and phenotypes has brought new opportunities for developing critical care medicine.This integration can reveal the molecular mechanisms and clinical characteristics of essential syndromes in an all-round and multi-dimensional manner，accurately identify the pathophysiological differences among different patient subgroups，and thus provide a solid and reliable basis for formulating individualized treatment plans.This not only effectively solves the problem of heterogeneity，but also significantly improves the therapeutic effects and prognosis，promoting the development model of the critical care medicine discipline to shift from the traditional population-based therapeutic effect exploration model to the individualized precision medical model.Looking to the future，critical care medicine will rely more on multi-omics technologies and big data analysis and is expected to achieve precise diagnosis and treatment management for critically ill patients，further improving the diagnostic and therapeutic level of critical care medicine and bringing more hope and blessings to critically ill patients.
Simulation-based medical education （SBME） utilizes high-fidelity simulation technology to provide a safe and controlled learning environment for critical care training，significantly enhancing both technical and non-technical skills of healthcare professionals.This paper systematically analyzes the application of SBME in critical care training in Hong Kong based on the Donabedian model （structureprocess-outcome）.At the structural level，Hong Kong has established high-fidelity simulation centers，developed specialized faculty，and refined governance frameworks to provide a solid foundation for SBME implementation.At the process level，SBME course design emphasizes backward design principles and taskcentered learning，integrating multidisciplinary team collaboration and structured debriefing to ensure training effectiveness.At the outcome level，SBME has significantly improved trainees' technical skills，teamwork，and crisis management abilities while also enhancing patient safety.Hong Kong's experience demonstrates that the successful implementation of SBME requires comprehensive structural support，scientifically designed curricula，and effective feedback mechanisms.This paper also explores strategies for promoting SBME in the Chinese mainland，recommending an approach that integrates local needs while drawing on Hong Kong's experience to advance the modernization of critical care medical education.
The rapid development of big data and artificial intelligence （AI） technologies has created the construction opportunities of intelligent ICU.The intelligent ICU integrates many technologies such as AI，internet of things，big data，robot and so on，which is the centralized integration of various advanced technologies in the ICU.The construction of intelligent ICU can improve the efficiency of early detection，prediction，auxiliary decision-making，resource allocation and remote，but it also faces challenges of data privacy，ethics and bias.The intelligent ICU in the future may be a doctor led decision-making “multimodal data AI algorithm intelligent device” framework.This article discusses the opportunities and challenges of intelligent ICU construction from the aspects of technical background，current applications，future prospects and challenges.
Similar to other clinical specialties，young ICU physicians commonly rely more on computer-based information for clinical decision-making while relatively neglecting bedside practice.This phenomenon may be largely attributed to the revolutionary advances in clinical diagnosis and treatment brought by rapid developments in biotechnology，information technology，materials science and computer technology.Other contributing factors include insufficient cognitive understanding of critical care issues，lack of clinical experience，excessive workload，and professional burnout.Currently，there is a notable paucity of relevant studies in Chinese ICUs.Future research should comprehensively analyze factors reducing ICU physicians'bedside time and explore effective strategies to promote their return to bedside care.
Sepsis frequently involve the lungs and is often complicated with sepsis-induced lung injury，which has a high incidence and mortality rate.However，current treatment strategies have not effectively reduce the mortality.Necessitating the exploration of more effective therapeutic measures.This article analyzes the recent development of the mechanisms and treatments of sepsis-induced lung injury and proposes possible innovative therapeutic directions.
Hemodynamic assessment and treatment are essential tools for reducing mortality in patients with shock.Goal-directed therapy （GDT） has provided critical care physicians with practical therapeutic targets and content during the early stages of shock resuscitation.However，during the phase of fluid optimization and maintenance，individual variability in patient responses makes it challenging to establish a unified treatment goal.Complications such as pulmonary edema caused by fluid overload，and arrhythmias and impaired tissue perfusion triggered by vasopressors，can prolong the duration of treatment and increase medical costs.With the continuous advancement of hemodynamic theory and technology，it has become possible to achieve individualized selection of resuscitation fluids，determination of individualized resuscitation responsiveness，and precise prediction and evaluation of resuscitation outcomes.This review focuses on the new concepts and advances in the treatment of shock hemodynamics in recent years，providing some reference for clinical treatment.
During the progression of sepsis，disruption of the intestinal barrier function and dysregulation of the immune system can trigger dysregulated inflammatory responses both locally in the gut and systemically.This leads to aberrant activation and migration of immune cells，thereby exacerbating pulmonary inflammation and tissue damage.Conversely，the onset of acute lung injury may further compromise the intestinal mucosal barrier，forming a detrimental bidirectional vicious cycle.Therefore，elucidating the mechanisms of immune cell migration and their role in gut-lung crosstalk can provide novel therapeutic targets for sepsis-induced acute respiratory distress syndrome.
Mechanical circulatory support plays an important role in the treatment of cardiogenic shock due to various etiologies.Selecting the appropriate timing and providing reasonable technical support are key to successful treatment.We will review the application of commonly used mechanical circulatory support technologies in cardiogenic shock.
The neuroendocrine regulatory paradigm of critical medicine has undergone revolutionary changes，from the “stress-related one-phase activation” model to the “ disease course related biphase response”model，from the “central one-way linear regulation” model to the “peripheral adaptive response” model，and from the “two- axes parallel activation” of the hypothalamic-pituitary-adrenal axis and sympathetic-adrenal medullary system to the “interactive feedback effect of the two axes” model，from the “neuroendocrine regulation” model to the “neuroimmune endocrine regulation” model.Correspondingly，the neuroendocrine regulation strategy is more inclined towards central intervention.On the one hand，it combines the replacement therapy of hypothalamic and pituitary hormones to avoid the negative feedback effect of peripheral hormones on the central nervous system and the inhibitory effects on the immune system in critical illness.On the other hand，through central or peripheral neural stimulation，not only the neuroendocrine function is improved，but also the immune function of patients can be enhanced.At present，with the assistance of new technologies （such as artificial intelligence），personalized and precise neuroendocrine regulation strategies need to be provided for clinical practice.
To develop a nomogram prediction model for weaning failure in mechanically ventilated critical ill patients in plateau areas.
Methods
A total of 255 patients requiring invasive mechanical ventilation admitted to the ICU of the People's Hospital of Xizang Autonomous Region between January 1 and December 31，2023，were enrolled.Based on weaning outcomes，patients were divided into a successful weaning group （184 cases） and a failed weaning group （71 cases）.Demographic characteristics，comorbidities，vital signs，and organ function parameters were collected and compared between the two groups.Statistically significant variables in univariate analysis were incorporated into multivariate logistic regression to identify independent risk factors for weaning failure.And a nomogram prediction model for weaning failure was established.
Results
Compared with the successful weaning group，the failed weaning group had significantly longer ICU stays，higher hospitalization costs，and increased 28-day mortality （all P＜0.001）.The multivariate regression analysis identified three independent risk factors for weaning failure：tidal volume （Vt） before weaning （P＜0.001，95%CI：0.979-0.992），respiratory rate （RR） before weaning（P=0.006，95%CI：1.034-1.218），and fluid balance in 24 hours before weaning （P=0.033，95%CI：1.000-1.001）.The area under the ROC curve of the prediction model was 0.883 （95%CI：0.841-0.925）.
Conclusions
Vt，RR，and 24-hour fluid balance levels before weaning significantly influence the incidence of weaning failure in mechanically ventilated critically ill patients in plateau areas.The nomogram prediction model developed for weaning failure in this study based on these three parameters，demonstrates a good predictive value.
To identify risk factors associated with 48-hour mortality following continuous renal replacement therapy （CRRT） initiation in patients with septic associated acute kidney injury（SAKI），and evaluate their predictive value for early mortality.
Methods
A retrospective cohort study of 258 SAKI patients who received CRRT in the Intensive Care Medicine Department of Beijing Friendship Hospital，Capital Medical University，between January 2016 and December 2021 was conducted.Patients were divided into survival group （203 cases） and non-survival group （55 cases） based on 48-hour mortality after CRRT initiation.Logistic regression was used to assess the risk factors for early mortality，and develop a composite predictor.Receiver operating characteristic （ROC） curve analysis was employed to assess the predictive performance of the combined prediction factor for early mortality.
Results
The 48-hour mortality rate was 21.3%.Multivariate logistic regression analysis revealed three independent risk factors for early death：lower creatinine levels ［OR=1.50 （per 100 μmol/L decrease），95% CI：1.15-1.95］，decreased oxygenation index［OR=1.05 （per 10 mmHg decrease），95% CI：1.02-1.09］，and elevated lactate levels ［OR=1.20 （per 1 mmol/L increase），95% CI：1.10-1.30］.The composite predictor showed an AUC of 0.804.
Conclusions
The low levels of creatinine and oxygenation index，as well as high lactate levels in critically ill SAKI patients receiving CRRT，significantly influence the early mortality.The derived composite predictor demonstrates clinically meaningful performance for early mortality risk stratification.
Viscoelastic measurement （VEM） provides an in vitro whole blood assay，enables realtime assessment of the dynamic coagulation process.With decades of clinical application，its use has expanded from traumatic hemorrhage，liver transplantation，and cardiac surgery to postpartum hemorrhage and critically ill neurological patients.In recent years，VEM has gained increasing prominence for evaluating coagulation function in critical care settings，with progressively broader applications.This article therefore focuses on the clinical utility of VEM in assessing coagulopathy in critically ill patients，with particular emphasis on its application in specific patient populations and relevant influencing factors.
Sepsis is the result of the interaction of multiple factors such as inflammation，immune activation，immune suppression，and hypoxia.Sepsis can lead to multiple organ dysfunction and has a high mortality rate.The clinical development of sepsis is often affected by multiple factors.PD-L1 has been proven to be a new prognostic biomarker for predicting mortality in sepsis.However，its role in sepsis-induced organ function The role of the PD-1/PD-L1 pathway in sepsis has not yet been determined.This review mainly introduces the latest research progress on the role of the PD-1/PD-L1 pathway in causing organ dysfunction in the progression of sepsis.To investigate whether blocking PD-1/PD-L1 pathway can improve organ dysfunction in patients with sepsis.
Acute respiratory distress syndrome （ARDS） is a common respiratory critical syndrome and one of the main causes of death in critically ill patients.It has been a hot and difficult point in respiratory and critical care medicine for many years.More and more studies have found that mitochondrial DNA （mtDNA）levels are associated with the development of ARDS.Plasma mtDNA levels are expected to be biomarkers for clinical diagnosis and evaluation of ARDS lung injury severity.In this review，we elaborate on the release and production of mtDNA and the underlying mechanisms leading to ARDS injury，prospecting for new therapies for ARDS targeting mtDNA.
A retrospective analysis was conducted on the clinical data of a patient with septic shock due to a urinary tract infection admitted to Guiqian International Hospital on March 21，2024.Using the keywords “Sepsis” and “Blood purification”，a literature search was performed in the CNKI and Wanfang databases.A search with keywords “Sepsis” and “Blood purification” in title/abstract was also conducted in the PubMed database.Clinical outcomes were compared between groups receiving SET or not in patients phenotyping with the above characteristics.The results showed，this case was characterized with high expression of inflammatory factors，rapid progression of organ damage and refractory shock.Based on well implementing sepsis bundle，SET restored circulation and the other vital organ function rapidly，resulting in a favorable prognosis.A literature review searched out 12 cases with the similar characteristics to this case.Of them，8 patients showed rapid improvement of organ function and survival after receiving SET，but 4 patients died of severe complications.Additionally，4 cohort studies were recruited in the literature review.The pooled data demonstrated that SET significantly reduced inflammatory cytokines and improved patient outcomes.It was suggested that，based on well implementing bundles，SET could be one of the interventions beneficial to outcomes in septic patient phenotyping with the above characteristics.
