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 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.

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.

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.

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.

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.

Objective

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.

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.

Patients in the ICU typically undergo frequent daily diagnostic tests to monitor hidden risks.Nevertheless, there are numerous additional repetitive, routine, and non-essential tests performed on regularly that are not specifically focused on addressing clinical concerns.Non-essential blood testing related to blood collection can lead to hospital-acquired anemia, which is associated with prolonged hospital stays,increased blood transfusion demand, and a higher mortality rate.Simultaneously, conducting non-essential testing imposes a significant economic strain.We reviewed the current situation, hazards, and measures of non-essential laboratory testing in the ICU, with the aim of increasing attention to ICU patients receiving nonessential blood testing and promoting high-quality development of the ICU.

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.

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.

Sepsis is an acute severe syndrome that develops into fatal organ dysfunction due to infection induced uncontrolled host response.Due to its complex and heterogeneous pathophysiology, sepsis has become the leading cause of death in critically ill patients.Transcriptomics refers to the collection of all transcription products in a cell under certain physiological or pathological conditions which reflects cellular activities in a specific environment and being studied with gene transcription and transcriptional regulation.In recent years, transcriptomics has made some breakthroughs in early identification, precise treatment and prognostic evaluation of sepsis, which is potential to construct a new system for diagnosing and managing sepsis.This paper reviews related articles to clarify research progress of transcriptomics in sepsis diagnosis and treatment.

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.

Airway closure refers to a lack of communication between proximal airways and alveoli due to airway collapse.It occurs in about 30% of patients, rising to up to 65% of patients with obesity and ARDS.“Liquid bridge formation,” “small airway compliant collapse,” or “surfactant depletion” can lead to airway closure, however, the exact mechanism is unknown.Airway closure not only affects the function of lung ventilation, but also in the process of mechanical ventilation, ignoring this phenomenon can lead to errors in lung recruitment assessment and respiratory mechanics measurement.This can affect the appropriate setting of ventilator parameters, even leading to or aggravating lung injury, and impacting on the fluid responsiveness assessment index based on heart-lung interaction.Airway closure can be monitored clinically by “low flow method” or “conductive pressure method”.This article reviews the phenomenon of airway closure and its impacts on respiration and circulation, emphasizing the importance of monitoring airway closure to deepen clinicians’ understanding and thereby improve the prognosis of mechanically ventilated patients with airway closure.

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.

Patient-ventilatory asynchrony (PVA) is common during mechanical ventilation, and is closely associated with elevated work of breath, prolonged mechanical ventilation, ventilator-induced lung injury,as well as worse clinical outcomes.Identifying PVA requires careful observation of the patient and their ventilator waveforms, but clinical healthcare providers vary in their ability to recognize PVA, and continuous bedside monitoring is challenging, urging the development of automated monitoring methods.PVA automatic detection algorithms have rapidly developed in recent years, showing a trend of synergistic development driven by data and knowledge.This article reviews the development history of PVA automatic detection methods, outlines the advantages and disadvantages of technologies based on rules, traditional machine learning, deep learning, and physiological system models, introduces the development and clinical application status of real-time PVA detection and analysis systems, and discusses the challenges faced in PVA detection based on mechanical ventilation waveform big data, such as the lack of standard datasets and insufficient algorithm generalization capability.