Sepsis is a pathologic syndrome of life-threatening organ dysfunction caused by a dysregulated host immune response to infection.Early and appropriate anti-infection treatment can improve the prognosis.β-lactam antibiotics are common antibiotics for the treatment of sepsis.Extended infusion of β-lactam antibiotics is a simple and effective method to optimize pharmacokinetic/pharmacodynamics and improve the efficiency.In the experts consensus, we discuss the basic theory, efficiency, safety, and clinical application on extended infusion of β-lactam antibiotics in adult sepsis patients, and summarize the evidence-based medicine for reference.

Acute respiratory distress syndrome (ARDS) is a type of non-cardiogenic pulmonary edema with a high mortality rate.With the pandemic of novel coronavirus infection (COVID-19), the diagnosis and treatment of ARDS have attracted renewed attention in clinical practice.Based on the updated evidence-based research, the American Thoracic Society issued guidelines for the treatment of ARDS in 2023, involving four parts: the use of corticosteroids, the selection of extracorporeal membrane oxygenation (ECMO), the application of neuromuscular blocking agents, and the use of positive end-expiratory pressure (PEEP) in ARDS patients.The guidelines recommends corticosteroids for patients with ARDS.Venovenous extracorporeal membrane oxygenation (V-V ECMO) is recommended for selected patients with severe ARDS.Neuromuscular blockers are recommended for patients with early severe ARDS.For patients with moderate-to-severe ARDS, a higher PEEP is recommended over a lower PEEP without lung recruitment maneuvers (LRMs).Prolonged lung recruitment maneuvers are not recommended for patients with moderate-to-severe ARDS.This article briefly interprets the relevant content in order to provide clinical references for the diagnosis and treatment of ARDS patients.

Objective

To analyze the resource allocation, indications, and clinical utilization of continuous renal replacement therapy (CRRT) in ICUs, and provide references for the development of relevant policies regarding the application of CRRT in ICU settings.

Methods

A cross-sectional survey from a total of 167 hospitals in 5 provinces from the eastern, central, and western regions of China from March 1 to 31, 2021 was conducted based on literature research and expert consultation, resulting in the creation of a questionnaire on the current application status of CRRT in medical institutions (ICU).The contents of the questionnaire mainly include:(1) resource allocation in each region (medical staff allocation and training of CRRT equipment configuration,management and operation of CRRT technology); (2) composition of indications (kidney disease and non-renal disease); (3) clinical application (treatment mode and treatment duration, use of replacement fluid and filter, regular quality control and disinfection measures); and (4) treatment effect (patient prognosis and treatment cost).

Results

In terms of resource distribution, CRRT equipment resources and human resources were more abundant in the eastern part of China, and the proportion of healthcare personnel who had participated in the standardized training on CRRT organized by national or provincial societies/associations was relatively low (38.54%-62.70% for physicians;18.86%-35.26% for nurses); in terms of clinical use, indications for CRRT in ICUs were predominantly for nonrenal diseases, with the top 3 indications were sepsis or infectious shock (17%), followed by acute (13%) or chronic(12%) renal insufficiency combined with circulatory instability, and there was little difference in the distribution of the top indications across the region; the 2 treatment modes with the most applications were CVVHDF (37%)and CVVH (33%); the duration of CRRT treatment in each province spanned a wide range, but with a sub-average treatment duration of ＞24 h (59.3%); on the whole, more commercial replacement solutions (65.44%) were used than handmade replacement solutions (34.56%), but the proportion of handmade replacement solutions was higher in some regions (＞50% in Jiangsu and Xinjiang); the frequency of filter replacement was affected by the mode of anticoagulation, and the highest frequency of filter replacement was found in the case of no anticoagulation (about 10.50 h/times), and the service life of the filter was longer in the case of anticoagulation with citrate (about 26.65 h/times).In terms of treatment effect, the overall case fatality rate of patients during hospitalization in ICU was 21.40%, and the proportion of patients still needing long-term dialysis after CRRT treatment was 20.19%, with a significant difference in treatment effect between Henan and Xinjiang and other regions; in terms of treatment cost,there was a big difference in the charges of CRRT in various regions, with a range of 80-130 yuan/h.The average cost of hospitalization for CRRT patients was 74 000/person, of which CRRT-related costs account for about 20%,and the reimbursement ratio of medical insurance was higher (about 70% overall); the fee schedule usually included healthcare personnel hourly fee, machine depreciation fee, and replacement fluid (accounting for ＞50% of the total), while anticoagulant and hemodialysis tubing were usually not included in the fee schedule (accounting for＜30% of the total), of which the price of dialysis tubing was higher, which had a greater impact on the overall cost.

Conclusion

In the future, coordinated planning of CRRT technical resources, promotion of standardized management of procedures, and establishment of quality control systems will be needed to achieve the goal of improving the quality and efficiency of medical institutions and intensive care departments.

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.

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.

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.

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.

Analgesia and sedation play important roles in critically ill patients, with the target shifting from improving patient comfort to organ function protection.For mechanically ventilated patients,the newly proposed concept of lung-protective sedation represents a further understanding of the inherent interconnection between optimizing mechanical ventilation, sedation strategies, and respiratory-related lungdiaphragm injuries.It also reminds clinicians that in the analgesic and sedation management of mechanically ventilated patients, they should evaluate and regulate respiratory drive and inspiratory effort in a targeted manner based on the arousal scale assessments to achieve the purpose of lung-diaphragm protective ventilation.

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.

Remimazolam Besylate is a novel, ultra-short-acting Benzodiazepine which rapidly hydrolyzed into an inactive carboxylic acid metabolite by non-specific tissue esterase.It has characteristics of fast onset, quick recovery, and predictable duration of action.Its sedative effect can be antagonized by Flumazenil.Prolonged infusion of Remimazolam besylate is unlikely to result in accumulation.Remimazolam Besylate has been currently approved for procedural sedation, induction and maintenance of general anesthesia in several countries.Preliminary studies have shown certain advantages in critically ill patients sedation.In this study, mechanisms, pharmacokinetics, clinical applications, adverse events and application prospects of Remimazolam besylate are reviewed to provide evidence for its development, research and application.

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.

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.

Atomization inhalation of antibacterial agents is one of the commonly used bundle airway management in mechanically ventilated patients with antimicrobial-resistant bacteria pneumonia and chronic pulmonary infection.This article reviews the clinical implementation of atomization inhalation of antibacterial agents in mechanically ventilated patients, including selection of antibacterial agent dosage form, drug configuration, use of atomization device, mechanical ventilation setting, and elaborates prevention and treatment of related adverse events, in order to standardize clinical nursing of atomization inhalation of antibacterial agents in mechanically ventilated patients and provide reference for formulating appropriate atomization management plan of antibacterial agents.

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.

Objective

To establish a quality control index system for continuous renal replacement therapy (CRRT), and explore key factors that affect outcome indicators by collecting real-world data.

Methods

A three-dimensional quality evaluation model as the theoretical framework was used, a quality control index system was constructed using literature analysis and expert consultation methods; information on patients receiving CRRT treatment from 6 hospitals in 4 provinces and 6 medical institutions were collected,and a retrospective cohort study was used to explore factors affecting outcome indicators.

Results

A total of 2 rounds of expert consultation were conducted, ultimately forming a CRRT quality control indicator system consisting of 2 first level indicators, 6 second level indicators, and 26 third level indicators; the results of multiple factor regression analysis showed that the indications for machine use and the type of disease diagnosis were key factors affecting the outcome indicators.

Conclusion

The CRRT quality control indicator system constructed in this study has a certain degree of scientificity and rationality, providing reference for clinical quality control of CRRT.In practice, key links that affect outcome indicators should be emphasized,and the CRRT clinical quality control indicator system should be continuously improved.