Durable mechanical circulatory support, represented by the left ventricular assist device (LVAD), plays an important role in the treatment of patients with end-stage heart failure. The introduction of levitation technologies (magnetic or hydraulic) has substantially improved the hemocompatibility and survival of LVAD, further transforming the therapeutic philosophy for LVAD (evidenced by increased proportion of destination therapy). In the future, fully implantable LVADs will further improve patients' quality of life, while physiologically adaptive pulsatile pumps are expected to achieve even greater improvements in hemocompatibility. This article provides a review of the application of durable mechanical circulatory support (dMCS) in patients with end-stage heart failure, focusing on the current status of LVAD, its indications and timing of surgery, as well as future development directions.

Septic shock is the most severe subset of sepsis, with a mortality rate of 30%-50%. In recent years, its treatment strategy has been shifting from a “one-size-fits-all” bundled approach to a “personalized” treatment model. This review, based on the core key links in the diagnosis and treatment of septic shock, proposes the EFSP framework for early key treatment strategies for septic shock: Early recognition and referral (E), Fast diagnosis and assessment (F), Standardized treatment (S), and Personalized treatment (P). It aims to provide clinicians with the latest progress in diagnosis and treatment, as well as practical guidance.

Blood glucose monitoring and management in critically ill patients constitutes an important part of intensive care. Continuous glucose monitoring (CGM) can improve the time in the target blood glucose range and reduce hypoglycemic events, and it has been widely used in patients with diabetes. Its advantages, including continuous glucose data collection, multiple glucose dynamic indicators, minimal invasiveness and reduced workload for medical staff, have drawn increasing attention from ICU clinicians. However, the clinical applicability of CGM in ICU patients remains controversial due to the critical conditions and rapid pathophysiological changes. This article elaborates on the recent progress regarding the accuracy of CGM in critically ill patients, as well as whether it can improve the quality of blood glucose control and clinical prognosis.

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.

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.

Septic shock is one of the most important threats to human life and health. Despite ongoing researches, the morbidity and mortality remain high. As a non-catecholamine-based vasoconstrictor, methylene blue has been shown in many studies to increase mean arterial pressure, reduce the need of catecholamine vasopressors and reduce the mortality of septic shock. However, these findings have not been consistently conclusive. This article reviewed the therapeutic effect of methylene blue in septic shock in this manuscript.

Fluid therapy runs throughout the hemodynamic treatment process for ICU patients. A precise fluid therapy strategy is key to implement individualized fluid management and organ protection. A fluid therapy approach guided by fluid responsiveness can help assess the effectiveness, limits, and optimal timing of fluid therapy by evaluating the body's volume responsiveness, fluid tolerance, blood pressure responsiveness, and perfusion responsiveness. This approach enables precise hemodynamic fluid management, identifies patients who truly benefit from fluid therapy, avoids organ dysfunction, and promotes the rapid recovery of critically ill patients.

To investigate the current practice in the diagnosis and treatment of hemorrhagic shock and trauma-induced coagulopathy (TIC) in ICUs across China.

A nationwide questionnaire-based survey was conducted among 1733 critical care physicians from 814 secondary and tertiary hospitals across all 31 provincial-level regions in China. The collected data were statistically analyzed to comprehensively evaluate key aspects and influencing factors in the management of these conditions.

The majority of respondents were from comprehensive ICUs in tertiary Grade A teaching hospitals. Heart rate (87.88%), blood pressure (93.83%), prothrombin time (98.27%), and fibrinogen level (94.40%) were the most commonly used indicators for diagnosing hemorrhagic shock and TIC and for guiding transfusion decisions. Physicians' perceptions regarding the choice of resuscitation fluids and blood products, goals of coagulation management, target ionized calcium level, core temperature control, and deep vein thrombosis prophylaxis were largely consistent with the European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: Sixth Edition. Several key discrepancies with the guideline were identified: viscoelastic testing was not widely used in clinical practice; fresh frozen plasma was still commonly used to correct hypoalbuminemia; calcium gluconate was preferred over calcium chloride for supplementing ionized calcium; and graduated compression stockings were considered effective for preventing lower extremity deep vein thrombosis.

Chinese intensivists demonstrate a relatively high level of knowledge in managing hemorrhagic shock and TIC.However, significant opportunities for standardization and improvement remain. Targeted training programs and quality control initiatives based on these survey findings are warranted to bridge the gap between current practices and evidence-based guidelines.

Sepsis is a life-threatening clinical syndrome with a high mortality rate globally. Chronic comorbidities are important factors influencing the clinical course and prognosis of sepsis. Chronic comorbidities are highly prevalent among sepsis patients, and those with chronic diseases exhibit relatively distinct physiological characteristics in immune response and vascular function. Moreover, patients with chronic comorbidities face higher mortality and poorer quality of life. In terms of treatment, uncertainty remains regarding the management of sepsis in patients with different types of comorbidities, particularly concerning anti-infection treatment, fluid resuscitation, and multiorgan support. Meanwhile, active and continuous post-ICU management is of great value. This review summarizes the disease burden and current research status of sepsis in patients with chronic comorbidities, aiming to provide a theoretical basis and reference for future mechanistic researches and precision treatment.

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.

Artificial intelligence (AI) is a new quality productive forces of modern information technology. It provides innovative approaches to optimize critical care workflows and improve patient safety and quality of care. In addition, AI promotes the development of scientific and precise critical care. This article reviews AI applications in critical care, analyzes current challenges and proposes corresponding strategies to support future advances of AI technology in critical care.

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.

To investigate the factors influencing the 28-day prognosis in patients with sepsis-associated severe thrombocytopenia and to develop and validate a clinical prognostic model.

Patients from the Medical Information Mart for Intensive Care (MIMIC-Ⅳ) v2.2 database were selected as the training cohort, and patients from the emergency intensive care unit (eICU) Collaborative Research Database served as the validation cohort. Patients diagnosed with sepsis-associated severe thrombocytopenia were included. Demographic data, vital signs, laboratory parameters, chronic comorbidities, treatment measures, and 28-day survival outcomes were collected. The least absolute shrinkage and selection operator (LASSO) and Bayesian information criteria were used to select variables for the prognostic model, and the model was externally validated using the eICU database.

1489 patients were included in the training cohort. Eight variables were selected: age, acute kidney injury stage, urine output, minimum blood urea nitrogen level, maximum heart rate, maximum international normalized ratio, minimum partial thromboplastin time, and the presence of liver disease. The C-index was 0.714 for the training cohort and 0.64 for the validation cohort. In the training cohort, the area under the curve for the 7-, 14-, and 28-day survival probabilities were 0.723, 0.733, and 0.736, respectively.

Key factors affecting the prognosis of patients with sepsis-associated severe thrombocytopenia were identified through multivariate analysis. A prognostic model incorporating eight variables was developed, which demonstrated good predictive performance for the prognosis of these patients.

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.

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.

To analyze the current research status and development trends in the field of diaphragm dysfunction and diaphragm-protective ventilation in mechanically ventilated patients.

Literature was retrieved from the Web of Science Core Collection database on January 9, 2025, covering studies published between 2005 and 2024. CiteSpace 6.4 R1 software was used to visualize and analyze the countries/regions, authors, keywords, and research hotspots of the included studies.

A total of 682 articles were included in the analysis. The top three countries by publication volume were the United States (200 articles), Canada (95 articles), and France (94 articles). The most prolific authors were Powers Scott K (55 articles), Martin Dres (34 articles), and Heunks Leo (34 articles). The five most frequently mentioned keywords were "diaphragm dysfunction" (520 times), "mechanical ventilation" (434 times), "ultrasound" (173 times), "frailty" (124 times), and "intensive care unit" (119 times). Burst analysis revealed that recent research emphasizes concepts such as "diaphragm thickening fraction", "critical care", and "invasive mechanical ventilation". Co-citation analysis identified the work of Levine et al. (2008) on diaphragm atrophy mechanisms and Goligher et al. (2018) on clinical translation as pivotal references.

Research on diaphragm-protective ventilation in mechanically ventilated patients is moving from mechanistic exploration to optimizing clinical strategies. However, there are limitations, including the incompleteness of the databases used and a lack of multicenter clinical validation. Future directions should focus on integrating intelligent monitoring technologies, advancing studies on molecular mechanism, and promoting individualized ventilation strategies through interdisciplinary collaboration to achieve synergistic protection of both the lungs and diaphragm.

Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is associated with reduced early postoperative survival among liver transplant recipients with acute-on-chronic liver failure (ACLF). We report the first case at our center in which Sulbactam-Durlobactam (SUL-DUR) was successfully used to treat a CRAB pulmonary infection patient with ACLF following liver transplantation. After initiating SUL-DUR therapy, next-generation sequencing (NGS) demonstrated a progressive decline in CRAB sequence counts. By day 4, CRAB-specific PCR of bronchoalveolar lavage fluid (BALF) returned negative, and CRAB was undetectable in subsequent BALF cultures. The treatment demonstrated favorable clinical efficacy, with notable radiological improvement and rapid microbial eradication. SUL-DUR not only rapidly controlled the progression of CRAB-induced pulmonary infection, but also facilitated the early initiation of immunosuppressive therapy. Subsequent in vitro antimicrobial susceptibility testing revealed synergy between SUL-DUR and cefepime, though no such synergy was observed with imipenem. This case underscores the promising role of SUL-DUR in managing post-transplant CRAB pneumonia, especially in high-risk patients with acute-on-chronic liver failure. Our findings may provide a valuable reference for optimizing therapeutic strategies in similar clinical cases.

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.

This retrospective cohort study, utilizing the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database, aimed to investigate the impact of platelet transfusion on prognosis of patients with sepsis-associated severe thrombocytopenia.

Patients diagnosed with sepsis-associated severe thrombocytopenia were identified from the MIMIC-Ⅳ database. Based on whether they received platelet transfusion, they were divided into transfusion and non-transfusion groups (PLT≤50×10⁹/L: 708 cases; PLT≤20×10⁹/L: 214 cases). Prognostic variables were identified using Least Absolute Shrinkage and Selection Operator (LASSO) regression. A Multivariable Cox proportional hazards model was constructed to assess the association between platelet transfusion and mortality, with hazard ratios (HRs) with 95% confidence intervals (CIs) calculated.

A total of 1,914 patients with sepsis-associated severe thrombocytopenia were included (PLT≤50×10⁹/L). Patients in the transfusion group had higher mortality rates (35.20%) and more requirements for organ support therapies (mechanical ventilation, renal replacement therapy, and extracorporeal membrane oxygenation usage rates: 57.10%, 13.80%, and 1.41%, respectively) than those in the non-transfusion group (23.10%, 38.30%, 8.60%, and 0.25%, respectively), with all differences being statistically significant (P<0.01). Multivariable Cox regression analysis showed that platelet transfusion did not significantly improve 28-days mortality at either PLT threshold (PLT≤50×10⁹/L: HR=1.10, 95% CI: 0.90-1.36, P=0.346; PLT≤20×10⁹/L: HR=0.94, 95% CI: 0.61-1.44, P=0.774). Age, white blood cell count, prothrombin time, and activated partial thromboplastin time were identified as independent predictors of poor prognosis, whereas, higher albumin levels were associated with improved outcomes.

Platelet transfusion strategies based on current thresholds (≤50×10⁹/L or ≤20×10⁹/L) did not demonstrate significant improvement in 28-day survival for patients with sepsis and severe thrombocytopenia in this retrospective analysis. These findings warrant validation through prospective studies.

Ventilator dependence has become a critical challenge in the field of critical care medicine. Among patients with chronic diseases, who often have multiple underlying systemic conditions, the incidence of ventilator dependence, weaning failure, and mortality are significantly higher than those in the general population, along with substantial medical resource consumption. Existing intervention strategies suffer from insufficient systematization, lack of individualization, and weak predicative capability. Based on multidimensional clinical data and AI technology, this paper proposes a full-chain precision intervention framework consisting of four components: risk identification, stratified intervention, dynamic monitoring and follow-up management. By integrating standardized data collection, construction of explainable AI models, phenotype-oriented modular interventions, and multicenter validation, it enables closed-loop management from risk prediction to clinical practice, providing theoretical and practical guidance for improving prognosis of ventilator-dependent patients with chronic diseases and optimizing medical resource allocation.