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。

In 2019, the European Society of Clinical Nutrition and Metabolism updated the guidelines for clinical nutrition of liver diseases, which lasted more than two years. It unified the recommendation of enteral and parenteral nutrition and firstly give the recommendation of nutrition management in patients with nonalcoholic fatty liver disease, cirrhosis with bone disease, cirrhosis with obesity, cirrhosis with oligomyopathy and nutrition-related liver injury. These recommendations have great value in guiding nutritional management of patients with liver diseases. We interpret the guidelines and reorganize the recommendations to improve the understanding and practicability.

The coronavirus disease 2019 (COVID-19) has become worldwide pandemic. Nowadays, different guidelines on diagnosis, treatments and prevention of the COVID-19 had been established by countries and international societies as well as the world health organization (WHO). However, the exact therapies were still controversial. Different guidelines may cast the difference of the medical service resources and the clinical traditions between countries. We compared different guidelines on COVID-19 between China, UK, USA, Japen and WHO, concentrating on the consensus and controversies, and got prepared for the potential outbreak of COVID-19 in this winter.

Airway clearance therapy is used to treat many diseases. This expert consensus is based on the impaired mechanism of airway clearance in critically ill patients, combined with the principles of pharmacologic and nonpharmacologic therapy, to select the appropriate treatment plan according to the following recommendations: (1) Hypertonic saline and isotonic saline atomization therapy can be used to induce the formation of sputum to facilitate specimen collection; (2) for patients with invasive mechanical ventilation, it is recommended that acetylcysteine be inhaled as needed according to the viscosity of airway secretion; (3) due to the lack of evidence on the safety and effectiveness of airway clearance drug inhalation, it is recommended not to use intravenous medication for aerosol inhalation; (4) before airway clearance, the causes of respiratory function and sputum excretion disorders should be evaluated to develop individualized airway clearance regimen; (5) PEP/OPEP can be used in the treatment of chronic obstructive pulmonary disease, cystic fibrosis, and bronchiectasis, which is more effective than conventional physical therapy, The therapeutic effect depends on the selected device, the set resistance and the compliance of patients; (6) the combined application of airway clearance technology is better than a single modality. For patients with artificial airways, tracheoscopy combined with vibratory sputum treatment significantly increases the clearance of airway secretions; (7) mechanical cough assistive technology can be used for patients with expiratory muscles weakness, but should be used with caution in patients with obstructive airway disease.