Despite significant advances in the field of critical care medicine over the past three decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the primary temporary mechanical circulatory support modality for patients with acute severe circulatory failure. With the accumulation of clinical experience and the increasing maturity of operational techniques in V-A ECMO, its technical management—particularly hemodynamic management—has become a key factor influencing patient outcomes. To further improve patient survival, the Chinese Critical Care Ultrasound Study Group, in collaboration with the Hemodynamic Therapy of Critical Care Collaborative Group and the Critical Care Medicine Branch of the China International Exchange and Promotive Association for Medical and Health Care, organized experts in critical care medicine to develop the Consensus on Hemodynamic Management in Adult Veno-Arterial Extracorporeal Membrane Oxygenation (2026 Edition). Based on years of clinical experience and the latest evidence-based medical evidence, this consensus formulates 15 systematic recommendations covering the entire process of V-A ECMO, including initiation, management during support, and weaning, aiming to promote standardized application of hemodynamic management in V-A ECMO.

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.

Onco-critical care has emerged as an important subspecialty at the intersection of critical care medicine and oncology, attracting increasing attention in recent years. With continuous innovations in cancer therapies, patient survival has improved significantly; however, the incidence of associated critical complications has also increased. The reasons for cancer patients requiring intensive care unit admission are diverse and can be broadly categorized into three groups: progression of the underlying malignancy, treatment-related complications, and coexisting classical critical illnesses. Traditional critical care concepts and practices face limitations in addressing the multidimensional and heterogeneous challenges of onco-critical care. Based on the core mechanism of critical illness development—host/organ unregulated response (HOUR)—this article systematically elaborates on how this framework advances understanding and clinical practice into onco-critical care, with emphasis on its manifestations in neuroendocrine, immune-inflammatory, and coagulation-metabolic pathways. The review summarizes recent advances in clinical assessment and phenotyping systems for onco-critical illness and discusses a multidisciplinary, integrated management strategy centered on the "Disease Control, Host Response Modulation, Organ Support" triad. Finally, major challenges and future directions in this field are outlined. By integrating existing evidence and theoretical insights, this review aims to provide new perspectives and a theoretical foundation for the clinical management of onco-critical illness, thereby promoting its evolution toward precision and standardization.

Cancer immunotherapy, particularly immune checkpoint inhibitors (ICIs), has significantly improved the prognosis of patients with various malignancies. However, the immune-related adverse events (irAEs) and associated organ dysfunction they trigger have become key issues affecting treatment safety and long-term patient survival. Pathophysiologically, irAEs share common features with classical critical illnesses like sepsis, both involving host/organ unregulated response (HOUR). The key distinction lies in irAEs primarily manifesting as overactivation of the immune system. Clinically, differentiating irAEs from infection in ICI-treated patients presenting with new-onset organ dysfunction is often challenging. Building upon the HOUR theoretical framework, this article proposes a PRISM management strategy integrating multi-omics technology, aiming to provide a personalized approach for the diagnosis and treatment of immunotherapy-related organ dysfunction. The PRISM strategy encompasses five key components: Precise etiological differentiation, Regulation of host response, Immunotherapy risk prediction, Support of organ function, and Multidisciplinary collaboration. By integrating multi-omics biomarkers and patient clinical characteristics, the PRISM strategy enables early warning and precise phenotyping of organ dysfunction and offers individualized intervention plans. It holds promise for significantly improving the clinical management of irAEs, enhancing patients' quality of life and long-term prognosis, thereby providing a theoretical foundation and practical guidance for the precise prevention and treatment of critical illnesses associated with immunotherapy.

The department of critical care medicine, the clinical base of critical care medicine, is the centralized management unit for the treatment of critical patients. Medicine and nursing are independent disciplines, but both can be fully utilized from different perspectives when dealing with critically ill patients. With the development of critical care medicine understanding and technology, the concept of doctor-nurse integration construction in the department of critical care medicine has emerged. Doctor-nurse integration construction in the department of critical care medicine needs to take severe diseases as the core and academic development as the orientation. Clinical practice should be carried out through medical cooperation, based on critical cognition and unified thinking mode.

Hospital acquired infections in critically ill patients are characterized by high incidence and poor prognosis, but the specific population may benefit from pharmacologic prophylaxis. For patients with ventilator-associated pneumonia, prophylaxis with systemic application or nebulized inhalation of antibiotics may be considered as a choice, depending on the characteristics of the patients and the time onset of the disease. For invasive aspergillosis (IA) in the department of critical care medicine, new perception is needed for its diagnosis and the need for prophylactic antifungal therapy should be evaluated for the high-risk group of IA. Reactivation of CMV is not uncommon in the department of critical care medicine, and prophylactic antiviral treatment may reduce the incidence of reactivation, but whether it improves clinical outcomes requires further exploration. When considering pharmacologic prophylaxis, it is necessary to conduct a thorough risk-benefit assessment of the target population, the type of drugs, and the mode of administration.

With the continuous exploration of the pathophysiological mechanisms of critical illness, the host response, a "bridge" between different etiologies and the development of critical illness, has received much attention. Host response is the focus of critical illness pathophysiology, and hemodynamics is the core of critical illness development. On the one hand, the host response has a significant impact on hemodynamics; on the other hand, the intervention of the host response through analgesic-sedative-anti-sympathetic therapy and the management of inflammation, immunity, coagulation, metabolism, and bioenergy can stabilize the hemodynamics and achieve the goal of critical illness treatment. A deepening understanding of host response not only enriches the connotation of hemodynamics but also facilitates further study and exploration of the pathophysiological mechanisms of critical illness. Therefore, we describe host response from three aspects: a new understanding of critical illness based on host response, the effect of host response on hemodynamics, and hemodynamic therapy based on the host response.

Neurocritical care is an important branch of critical care medicine. The mechanism of critical neurological damage is complex and diverse, and the pathophysiology changes rapidly. Different pathophysiological changes determine different degrees of brain injury. In a special plateau environment, the incidence of critical neurological disease is higher, the age of onset is younger, the disease progress is faster, and the degree of damage is more severe. In order to standardize the diagnosis and treatment, enhance monitoring and management, provide timely and precise treatment, prevent irreversible brain injury, and improve the prognosis of patients with critical neurological illness at high altitudes, the Research Group of Calm Treatment of China, Research Group of Critical Care Ultrasound of China, and the Quality Control Center of Critical Care Medicine in Tibet formulated the Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes on the basis of full discussion and communication of relevant critical medical experts and neurosurgery experts according to domestic and foreign literature and years of experience in clinical application and promotion. The main contents of the consensus are as follows.

(1) According to the pathophysiological mechanism of neurological involvement in critical illness, scenarios of neurocritical care at high altitudes can be divided into cerebral hemorrhage at high altitudes, severe traumatic brain injuries, ischemic stroke, cerebral edema at high altitudes, and septic encephalopathy (8.4 points).

(2) It is recommended to use cerebral blood flow, brain function monitoring and cerebral oxygen saturation as a "triad" monitoring core in management of neurocritical care at high altitude, to as well as cerebrospinal fluid dynamics monitoring and brain structure surveillance (9.0 points).

(3) It is recommended to grade patients quickly, and the "5-avoids" approach based on "brain protection" theory were adhered to avoid fever, seizures, anxiety, agitation or pain, shivering, stimulation and nociception, according to different levels. Especially in the "super critical" stage, with the protection of "446"targets, choose the window for analgesia and sedation (8.4 points).

(4) It is recommended to monitor systemic and cerebral hemodynamic continuously and dynamically in order to improve systemic perfusion and optimize cerebral perfusion simultaneously (8.4 points).

(5) It is recommended to choose the method of direct measurement of intracranial pressure by intraventricular catheter or optic nerve sheath diameter under ultrasound to estimate intracranial pressure, and choose the appropriate target mean arterial pressure to ensure optimal brain perfusion (8.8 points).

(6) It is recommended to use transcranial Doppler ultrasound to evaluate the blood flow velocity and blood flow waveform of the bilateral cerebral arteries. It is recommended to target the blood flow velocity of M1 at 40 cm/s in the "super critical" period (8.2 points).

(7) In the "super critical" period, we recommend to routinely monitor BIS and maintain the BIS value around 40 as the goal to guide the depth of sedation; those with conditions can be monitored by quantitative electroencephalography to assist determining whether there are non-convulsive seizures, and perform diagnostic evaluation of the prognosis (8.6 points).

(8) It is recommended to monitor brain oxygen levels routinely, starting early in the ICU admission of patients with critical neurological conditions at high altitudes, which can assist in the assessment of brain damage (8.6 points).

(9) It is recommended to evaluate the cerebral blood flow self-regulation ability routinely to achieve the optimal cerebral perfusion pressure in time and timely adjust the intensity and scheme of treatment (8.2 points).

(10) It is recommended to emphasize the importance of target arterial partial pressure of carbon dioxide in the artery in critical illness and neurocritical care at high altitudes (8.0 points).

(11) It is recommended to devote attention to the importance of targeted temperature management in in critical illness and neurocritical care at high altitudes (8.6 points).

(12) It is recommended that multidisciplinary consultation and multi-professional cooperation could improve the management in critical neurological illness at high altitudes (8.8 points).

(13) It is recommended that the constitution of improvement in brain structure imaging, pressure normalization of cerebrospinal fluid and restoration of cerebral blood autoregulation could be as the de-escalation triad (8.0 points).

(14) It is recommended to be cautious of paroxysmal sympathetic hyperreactivity patients in neurocritical and critical illness at high altitude (8.0 points).

(15) It is recommended to be cautious about the management of agitation (delirium) and cognitive function of patients in TBI at high altitudes(8.0 points).

(16) It is recommended to assess the itinerary of the rehabilitation in a timely manner for critically sick patients at high altitudes (8.2 points).

(17) It is recommended to be cautious of post-traumatic hydrocephalus and related neuroendocrine abnormalities in patients with critical neurological illness at high altitudes (7.6 points).