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.

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.

Retrospective studies based on the new global definition of acute respiratory distress syndrome （ARDS） have elucidated the changes brought about by these new criteria from the perspective of diagnostic scope. The updated ARDS guideline from the American Thoracic Society conditionally recommend the use of glucocorticoids，providing new insights into treatment. Innovations explorations non- and invasive respiratory support strategies have demonstrated highlighted advantages in specific populations，promoting the optimization of clinical practices. The analysis of key bottlenecks in delayed weaning highlights the importance of screening，contributing to improve weaning practices. This review highlights critical scientific research advancements in the field of critical respiratory medicine in 2024.

Sepsis，as a major challenge in critical care medicine，is fundamentally characterized by dysregulated host immune response. This paper elucidates the latest research advancements from the following four perspectives：mechanisms of host immune response dysregulation，new methods for immune monitoring，precision immunotherapy strategies，and the developmental prospects of a stepwise approach to precision treatment in sepsis. This review summarizes current progress in sepsis immunotherapy，explores its challenges and opportunities，and provides new insights for precision immunotherapy in sepsis.

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.

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.

软性支气管镜自20世纪60年代在临床应用以来，其迅速成为诊断和治疗气道和肺实质疾病至关重要的方法，并在支气管镜检查室和ICU得以广泛应用。2009年，一次性软性支气管镜（single-use flexible bronchoscopes，SUFB）开始应用于困难气道气管插管。10余年来，SUFB的图像质量、可操作性及功能不断改进，与可重复使用软性支气管镜（reusable flexible bronchoscopes，RFB）相比，其性能和成本均达到可接受的水平，并极大地减少了支气管镜检查相关的交叉感染，显著提高了患者的安全性，且便于携带、易于获取，在紧急情况下可立即使用，使用后不需再处理，降低了清洁和存储成本。SUFB已经在ICU、手术室、支气管镜室等环境中不断应用，尤其在新型冠状病毒感染（corona virus disease 2019，COVID-19）大流行初期，考虑到使用RFB存在病毒传播风险，SUFB受到重视，包括美国支气管病学和介入肺病学会（American Association for Bronchology and Interventional Pulmonology，AABIP）、西班牙肺病学和胸外科学会（Spanish Society of Pneumology and Thoracic Surgery，SEPAR）和阿根廷支气管病学会（Argentine Society of Bronchchiopathy，AABE）等均推荐SUFB在已知或疑似感染严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome coronavirus 2，SARS-CoV-2）的患者中使用。

The Chinese Society of Critical Care Medicine (CSCCM) has developed the clinical practice guidelines of nutrition assessment and monitoring for patients in adult intensive care unit (ICU) of China. This guideline focuses on nutrition assessment and metabolic monitoring to achieve the optimal and individualized nutrition therapy for critical ill patients. This guideline was made by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough system review and summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and review by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on the currently available evidence and cover several key fields, including nutrition risk screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the PICO principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3 to 5 years.

血小板减少症是指外周血中血小板计数（platelet，PLT）<100×10⁹/L而引起的临床综合征。据报道有13.0%~44.1%的重症患者可能发生血小板减少症，且血小板减少的程度是重症患者预后的重要预测指标之一。重症患者发生血小板减少症的原因众多，其中脓毒症相关的血小板减少症（sepsis induced thrombocytopenia，SIT）最为常见，约占50%。SIT的发生不仅延长重症患者ICU住院时间、机械通气时间及血管活性药物使用时间，同时可能导致出血相关性不良事件及全因病死率增加。目前尚缺乏SIT的监测、诊断及治疗规范，因此中华医学会重症医学分会专家制定《脓毒症相关的血小板减少症临床诊疗中国专家共识》，以期对此疾病进行规范化管理。

环泊酚是中国自主研发且具有全球自主知识产权的1类创新药。为规范和优化环泊酚的临床应用，2021年国内专家组曾撰写《环泊酚临床应用指导意见》。该指导意见对帮助临床医师了解环泊酚的药理学特性及其临床应用起到了一定作用。近年来，环泊酚在麻醉学和重症医学领域得到广泛应用，积累了大量的临床经验和临床研究资料。因此有必要对《环泊酚临床应用指导意见》进行补充和修订，以更好地指导临床应用。