Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is the primary cause of mortality in sepsis, with its core pathophysiological mechanism being severe ischemia and hypoxia in critical units—composed of microcirculation and the mitochondria of functional cells—resulting from disruptions in blood flow and oxygen flow following a dysregulated host response. Due to the systemically convergent yet clinically heterogeneous nature of the host response, current understanding and management strategies for hemodynamics remain inconsistent, often leading to inadequate resuscitation or overtreatment. To improve the quality of care, based on a systematic review of the "blood flow-oxygen flow" theory, an expert panel emphasizes reevaluating septic shock from an integrated perspective of blood flow and oxygen flow, and has formulated the Expert Consensus on Blood Flow and Oxygen Delivery Phenotyping and Clinical Management of Septic Shock (2025). The consensus proposes that clinical typing of blood flow-oxygen flow should comprehensively consider cardiac function, vascular tone, oxygen flow utilization status in critical units, and disease trajectory, while optimizing subtype identification by integrating host response phenotypes and artificial intelligence technologies. It advocates establishing a continuous assessment system through multi-site oxygen flow monitoring for organ perfusion, peripheral perfusion monitoring, and critical care ultrasound. Under the framework of the "critical care triangle", the consensus promotes the implementation of individualized, bundled management strategies, providing guidance for multiple management points to restore blood flow-oxygen flow matching, reduce the risk of organ failure, and decrease patient mortality.

Neurocritical care involves complex pathophysiological mechanisms, and its incidence is higher, injuries are more severe, and treatment is more challenging in high-altitude environments. This consensus, based on the latest domestic and international evidence-based medical data, establishes a standardized, goal-oriented framework for neurocritical care management applicable in high-altitude regions and nationwide. The consensus was developed following international standards for evidence quality assessment and underwent two rounds of Delphi expert consultation, resulting in 32 recommendation statements covering three parts: management systems, monitoring and assessment, and core strategies. Key updates include: advocating for the establishment of independent neurocritical care units and implementing precise tiered diagnosis and treatment based on the "Five Differences in Critical Care" concept; constructing a "trinity" multimodal brain monitoring system centered on cerebral blood flow, cerebral oxygenation, and brain function, emphasizing routine bedside transcranial Doppler ultrasound, cerebral oximetry, and continuous electroencephalography monitoring; shifting management strategies from mild hypothermia therapy to targeted temperature management, and defining the "446" target management pathway for the supercritical stage; emphasizing the assessment of static and dynamic cerebrovascular autoregulation functions through multimodal methods to achieve individualized optimal mean arterial pressure management; elevating cerebrospinal fluid management goals to the level of "glymphatic system" function maintenance; implementing a multidisciplinary collaborative, whole-process management model focusing on patients' long-term neurological functional outcomes; de-escalation criteria include multidimensional indicators such as recovery of brain structure, restoration of cerebrovascular autoregulation, improvement in cerebrospinal fluid dynamics, and reduction in biomarker levels; and integrating cutting-edge technologies like artificial intelligence into post-critical care management and rehabilitation planning. This consensus systematically integrates the entire process of neurocritical care management, reflecting the modern connotation of goal-oriented, dynamic, and multimodal integration in neurocritical care medicine. It aims to adapt to new trends such as deepening understanding of pathophysiological mechanisms, the integration of medicine and engineering, and the empowerment of artificial intelligence, thereby further advancing the discipline of critical care medicine.

Objective To develop a neural network-based deep learning model for predicting postoperative recurrence in thyroid tumor patients and validate the model with external datasets for providing clinicians with a reliable decision support tool.Methods An artificial neural network structure was adopted in the study,with thyroid tumor data from the SEER database serving as the training set.External validation was conducted with open-source data from the University of California,Irvine(UCIrvine),and the data from 100 patients at a general tertiary hospital in Hunan province.The model's accuracy and reliability in predicting recurrence were evaluated through multiple performance metrics.Results Experimental results showed that the model outperformed Logistic model in recurrence prediction,with accuracy,recall rate,precision and F1 score reaching 0.915 3,0.981 8,0.921 1 and 0.947 4 in internal validation.Moreover,the model achieved accuracies,recall rates,precisions,F1 scores and ROC_AUC values of 0.832 9,0.945 5,0.841 4,0.890 4 and 0.78 on the UCIrvine validation set,while 0.870 0,0.880 0,0.862 7,0.871 3 and 0.80 on the local validation set.Conclusion This neural network-based predictive model exhibits excellent performance in thyroid tumor recurrence prediction,providing clinicians with a valuable decision support tool that can help optimize postoperative treatment plans and improve patient prognosis management.

Sepsis is a common critical illness in clinical practice,characterized by rapid progression and high mortality.Its complex pathogenesis remains a major focus and challenge in the field of critical care medicine.Disseminated intravascular coagulation(DIC)is one of the most frequent and severe complications of sepsis,featuring systemic activation of the coagulation cascade and microthrombus formation,significantly increasing the mortality.Coagulation factorⅫ(FⅫ),a serine protease,is considered to have therapeutic potential for thrombosis without impairing normal hemostasis.Study reveal that neutrophil extracellular trap(NET),web-like DNA structures released through a unique process known as NETosis,provide negatively charged scaffolds that promote FⅫ binding and activation,thus triggering the intrinsic coagulation cascade and contributing to a hypercoagulable state.In recent years,increasing attention has been paid to the interaction between NET and FⅫ in sepsis complicated with DIC.These 2 factors play central roles in intravascular thrombus formation and coagulation activation.Beyond their antimicrobial function,NET can aggravate tissue injury and coagulation abnormalities by releasing proinflammatory mediators such as myeloperoxidase(MPO),neutrophil elastase(NE),and reactive oxygen species(ROS).FⅫ activation can further trigger the kallikrein-kinin system(KKS)and activate FⅪ,amplifying inflammation and thrombosis in a vicious cycle.Traditional Chinese medicine(TCM),as a key component of Chinese medical heritage,has demonstrated unique advantages in managing sepsis and its complications.Based on therapeutic principles such as"strengthening healthy qi and eliminating pathogenic factors"and"tonifying qi and activating blood circulation",TCM is believed to regulate immune function and correct coagulation disorders,thereby interfering with the hypercoagulable state mediated by NET and FⅫ,slowing the progression of DIC,and improving clinical outcomes.Several herbs,including Salvia miltiorrhiza,Astragalus membranaceus,Rheum officinale,Ligusticum chuanxiong,and Curcuma longa,have shown anticoagulant,antiplatelet,and anti-inflammatory properties.In addition,compound formulations such as Xuebijing injection and Qingwen Baidu decoction have demonstrated clinical efficacy in improving coagulation parameters,reducing D-dimer levels,and protecting organ function.Although current evidence on the effects of TCM on NET formation and FⅫactivation is still limited,its potential mechanisms and clinical value warrant further investigation.This review summarizes the critical roles and interplay of FⅫand NET in sepsis complicated with DIC and discusses the advances in TCM-based interventions,aiming to provide new perspectives for mechanism-oriented research and integrative therapeutic strategies.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To develop a neural network-based deep learning model for predicting postoperative recurrence in thyroid tumor patients and validate the model with external datasets for providing clinicians with a reliable decision support tool.Methods An artificial neural network structure was adopted in the study,with thyroid tumor data from the SEER database serving as the training set.External validation was conducted with open-source data from the University of California,Irvine(UCIrvine),and the data from 100 patients at a general tertiary hospital in Hunan province.The model's accuracy and reliability in predicting recurrence were evaluated through multiple performance metrics.Results Experimental results showed that the model outperformed Logistic model in recurrence prediction,with accuracy,recall rate,precision and F1 score reaching 0.915 3,0.981 8,0.921 1 and 0.947 4 in internal validation.Moreover,the model achieved accuracies,recall rates,precisions,F1 scores and ROC_AUC values of 0.832 9,0.945 5,0.841 4,0.890 4 and 0.78 on the UCIrvine validation set,while 0.870 0,0.880 0,0.862 7,0.871 3 and 0.80 on the local validation set.Conclusion This neural network-based predictive model exhibits excellent performance in thyroid tumor recurrence prediction,providing clinicians with a valuable decision support tool that can help optimize postoperative treatment plans and improve patient prognosis management.

Sepsis is a common critical illness in clinical practice,characterized by rapid progression and high mortality.Its complex pathogenesis remains a major focus and challenge in the field of critical care medicine.Disseminated intravascular coagulation(DIC)is one of the most frequent and severe complications of sepsis,featuring systemic activation of the coagulation cascade and microthrombus formation,significantly increasing the mortality.Coagulation factorⅫ(FⅫ),a serine protease,is considered to have therapeutic potential for thrombosis without impairing normal hemostasis.Study reveal that neutrophil extracellular trap(NET),web-like DNA structures released through a unique process known as NETosis,provide negatively charged scaffolds that promote FⅫ binding and activation,thus triggering the intrinsic coagulation cascade and contributing to a hypercoagulable state.In recent years,increasing attention has been paid to the interaction between NET and FⅫ in sepsis complicated with DIC.These 2 factors play central roles in intravascular thrombus formation and coagulation activation.Beyond their antimicrobial function,NET can aggravate tissue injury and coagulation abnormalities by releasing proinflammatory mediators such as myeloperoxidase(MPO),neutrophil elastase(NE),and reactive oxygen species(ROS).FⅫ activation can further trigger the kallikrein-kinin system(KKS)and activate FⅪ,amplifying inflammation and thrombosis in a vicious cycle.Traditional Chinese medicine(TCM),as a key component of Chinese medical heritage,has demonstrated unique advantages in managing sepsis and its complications.Based on therapeutic principles such as"strengthening healthy qi and eliminating pathogenic factors"and"tonifying qi and activating blood circulation",TCM is believed to regulate immune function and correct coagulation disorders,thereby interfering with the hypercoagulable state mediated by NET and FⅫ,slowing the progression of DIC,and improving clinical outcomes.Several herbs,including Salvia miltiorrhiza,Astragalus membranaceus,Rheum officinale,Ligusticum chuanxiong,and Curcuma longa,have shown anticoagulant,antiplatelet,and anti-inflammatory properties.In addition,compound formulations such as Xuebijing injection and Qingwen Baidu decoction have demonstrated clinical efficacy in improving coagulation parameters,reducing D-dimer levels,and protecting organ function.Although current evidence on the effects of TCM on NET formation and FⅫactivation is still limited,its potential mechanisms and clinical value warrant further investigation.This review summarizes the critical roles and interplay of FⅫand NET in sepsis complicated with DIC and discusses the advances in TCM-based interventions,aiming to provide new perspectives for mechanism-oriented research and integrative therapeutic strategies.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

The department of critical care medicine has a high prevalence of hospital acquired infections, which are closely associated with prognosis of critically ill patients. With hospital acquired infections as the axis, the treatment of critically ill patients can be divided into three phases: management of the primary disease and support of organ function, treatment of various complications resulting from the primary disease, and control of further damage and new complications. The cycle of the last two phases may put the patient in a state of Persistent inflammation, Immunosuppression, and Catabolism Syndrome (PICS), which ultimately leads to a poor prognosis. Fine control of the above three stages to reduce the risk of hospital acquired infections is a non-negligible component of the critical care process. Therefore, how to understand, prevent and treat hospital acquired infections is a top priority in the current development of critical care medicine. This review provides a comprehensive overview of strategies for the prevention and management of hospital acquired infections in critical care, covering five areas: changing the perception of hospital acquired infections, standardizing specific prevention interventions, consolidating the theoretical basis, recognizing that hospital acquired infection prevention are treatments, and integrating treatment to quality assurance. The aim is to develop the concept of severe treatment based on the prevention and control of severe patients, reduce the risk of hospital acquired infections of severe patients and improve the quality of critical care.

Catheter related blood stream infection (CRBSI), a common complication in the department of critical care medicine, may result in longer stay in the department of critical care medicine, increased hospitalization costs, even sepsis that leads to increased mortality in severe patients. The infection control of CRBSI has become the focus of the department of critical care medicine and even hospital management as well as the core of quality control. At present, the prevention program of CRBSI in the department of critical care medicine has been basically in place, and the national standards for infection prevention during central venous catheter placement and maintenance have been established. The establishment and implementation of these norms can effectively reduce the incidence of CRBSI, but CRBSI in the department of critical care medicine is still common and serious, indicating that there are defects in the aseptic operation during central vein catheterization and use. The corre- sponding operation process should be investigated and improved, and efforts should be made from the aspects of theory, management, education, norms, and supervision to avoid or reduce the occurrence of CRBSI and even achieve zero infection by improving and implementing various sensory control requirements in clinical operation.