Analgesia and sedation are crucial for critically ill patients. In recent years, a comprehensive strategy featuring prioritized analgesia, light sedation, delirium screening and prevention, early mobility and sleep improvement has been formed. However, a concise and easy-to-operate flow chart still needs to be improved. We have developed a protocolized process for pain and agitation management for critically ill patients to provide a hands-on tool in clinical practice.

Neurocritical care is an emerging specialty integrating critical care medicine and neuroscience. Neurocritical care specialty in China started late, due to lack of data on medical resources, and complex professional background of specialists in Neuro-critical care unit. Without standardized neurocritical care specialist training in China, there is an urgent need for neurocritical care specialist training. According to successful experience of previous specialized training in China and foreign countries, before establishing a standardized specialized training, priority should be given to core competencies in this specialty. A working Group from Neuro-Critical Care Committee affiliated to the Chinese Association of Critical Care Physicians and the National Center for Healthcare Quality Management in Neurological Diseases established the consensus through formal consensus methods (modified Delphi method and nominal group method). The working group first compiled the previous guidelines and then issued an online questionnaire. 1094 respondents from 33 provinces in China participated in the online survey. A formal list containing 329 statements was generated for rating by a nominal group. After five rounds of nominal group meetings and one round of comments and iterative review, 198 core competencies (54 on neurological diseases, 64 on general medical diseases, 42 on monitoring of practical procedures, 20 on professionalism and system management, 5 on ethical and legal aspects, 3 on the principles of research and certification, and 10 on scoring systems) formed the final list. The list can be used as a reference for neurocritical care training in the future.

Prone position ventilation (PPV) is a technique of respiratory support for patients under a prone position. PPV has the advantages of promoting collapsed alveolar recruitment, enhancing ventilation/perfusion ratio, improving respiratory system compliance, facilitating secretion drainage, and reducing ventilator-associated lung injury. However, there is no unified recommendations for the timing of PPV initiation. For patients with moderate and severe ARDS, PPV is now recommended by guidelines for mechanical ventilation of acute respiratory distress syndrome (ARDS). Considering that ventilator-associated lung injury complicates ARDS, PPV should be implemented as soon as possible for patients with traditional ARDS. For those receiving extracorporeal membrane oxygenation (ECMO), it is recommended to start PPV at the early stage of ECMO support in ECMO centers. The timing of PPV for intubated COVID-19 patients with poor respiratory compliance can refer to patients with traditional ARDS. The timing for awake PPV in COVID-19 gradually moves forward. Even if oxygenation does not dramatically drop, PPV can be started in COVID-19 patients as long as they are tolerable and have no contraindications.

The surviving sepsis campaign (SSC) guidelines has been updated five editions nowadays since it first published in 2004. SSC guidelines promote knowledge about sepsis constantly, which also improve management of sepsis to a certain extent, and become an important basis for guiding diagnosis and therapy in patients with sepsis. However, there are still several obvious defects in early resuscitation of septic shock in the SSC guidelines 2021, and the relevant recommendations may lead to misinterpretation or misuse. Therefore, "eight pitfalls" and relevant clinical evidence in SSC guidelines 2021 are discussed in present commentary.

Critically ill patients with COVID-19 at high altitudes were difficult to recognize and diagnose, due to hypoxemia associated with high altitudes and various chronic co-morbidities. In order to standardize the diagnostic and treatment practice, the present expert consensus was established by the method of consensus meeting, according to the Diagnostic and Treatment Regimen of COVID-19 (version 9), investigation advances abroad and domestic, and expert opinions, focusing on the common and important issues of diagnosis and treatment practice of critically ill patients with COVID-19 at high altitudes. This consensus will provide a reference for the standardized treatment of critically ill patients with COVID-19 at high altitudes in China.

Chinese Association of Critical Care Physicians has been devoted to development of standardized critical care training program in the past three years. An integrated postgraduate training system including resident and specialist standardized training protocol has been forming. Short-run working scheme is to refine the program in all aspects, including further standardization of training curriculum, training center supervision, training faculty qualification and web-based supporting system.