Early diagnosis of intensive care unit-acquired weakness (ICUAW) is crucial for improving the outcomes of critically ill patients. Hence, this study was designed to identify predisposing factors for ICUAW and establish a predictive model for the early diagnosis of ICUAW. This prospective observational multicenter study included septic patients from the comprehensive ICUs of West China Hospital of Sichuan University and 10 other hospitals between September and November 2023. Inclusion criteria were as follows: age over 18 years; expected ICU stay longer than 3 days; and voluntary informed consent. Patients were classified into ICUAW (MRC score < 48) and non-ICUAW (MRC score ≥ 48) groups based on muscle strength assessments. The analyzed key predictive factors encompassed demographic data, SOFA and APACHE II scores, inflammatory markers (PCT, IL-6, and CRP), and ultrasound measurements of muscle thickness and cross-sectional area. Logistic regression analysis was conducted for variable selection and nomogram model construction. A total of 116 septic patients were included, comprising 77 males and 39 females (mean age: 56.94 ± 19.90 years). A nomogram model predicting ICUAW probability was developed, which involved vastus intermedius diameter, rectus femoris cross-sectional area, IL-6, and CRP. The AUC of the composite diagnostic ROC curve was 0.966 (95

Coagulopathy is a common complication and heterogeneous syndrome of sepsis. Longitudinal data are essential for capturing the complexity and heterogeneity of coagulopathy in sepsis. The dynamic changes in coagulation profiles, their characterization, and prognostic implications remain poorly understood. We hypothesized that sepsis patients develop distinct coagulopathy sub-phenotypes. Using longitudinal data, we first aimed to identify these sub-phenotypes, then characterize their trajectories, and finally evaluate their association with 28-day mortality and explore potential influencing factors. We conducted a retrospective analysis using Group-based Trajectory Modeling to investigate patterns of coagulation changes and their association with 28-day mortality in sepsis patients from West China Hospital of Sichuan University (2015–2022). The Cox proportional hazards regression model was used to investigate the relationship between trajectory groups and prognosis. Subgroup analyses were performed to explore potential influencing factors further. A total of 1649 patients were included, and 3 distinct trajectory sub-phenotypes were identified based on model fit indices and clinical interpretability. Group 1 (N = 818, 49.6

Intensive care unit-acquired weakness (ICUAW) is frequent in critically ill adults and is associated with adverse outcomes, but early recognition is difficult because standard diagnosis relies on volitional strength testing. In this prospective multicentre cohort study across 16 tertiary ICUs in southwest China, adults expected to remain in the ICU for ≥ 3 days underwent quadriceps ultrasound and routine clinical assessment within 24 h of admission. ICUAW was defined by the first evaluable Medical Research Council (MRC) score during ICU stay. We developed and compared nine algorithms in a development cohort (n = 858) and performed temporal external validation in a later cohort (n = 345). ICUAW occurred in 579/858 (67.5

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.

BackgroundSystemic vascular resistance is conventionally assessed using invasive methods; the snuffbox artery resistance index (RI) is a superior non-invasive predictor of lactate clearance in septic shock patients to the perfusion index. However, the normal reference ranges of the snuffbox artery RI and pulsatility index (PI) remain undefined, with inconsistent RI data in healthy populations due to non-standardized measurements.ObjectiveThis study aimed to establish the normal reference ranges for the snuffbox artery RI and PI in healthy volunteers and to compare these hemodynamic parameters between healthy volunteers and intensive care unit (ICU) patients to evaluate their clinical utility in assessing peripheral microcirculation.DesignThis was a single-center prospective observational cohort study.SettingThis study was conducted at a 4,900-bed tertiary care hospital with a 215-bed closed ICU in China.ParticipantsA total of 91 healthy volunteers—stratified by history of hypertension and age—and 55 ICU patients—classified by shock status—were included in the study from February to November 2024.InterventionsNo interventional measures were implemented; all data were collected through a non-invasive ultrasound and clinical record review.Measurements and main resultsUltrasound parameters and vital signs were measured under standardized conditions. The normal RI and PI ranges in healthy volunteers were 0.72–0.75 and 1.93–2.03, respectively. Significant differences in the RI and end-diastolic flow velocity (EDV) were found between healthy volunteers and ICU patients (all p < 0.001), with no differences in the peak systolic flow velocity (PSV) or PI. EDV was associated with 28-day mortality in patients (p < 0.05). Volunteers had significant post-exercise EDV changes, and hypertension/age had no effect on their vascular tension parameters. After excluding 5 patients, the remaining 50 shock and non-shock ICU patients showed no significant differences in all snuffbox artery parameters.ConclusionThis study established standardized normal reference ranges for the snuffbox artery RI and PI in healthy adults and found significant RI and EDV differences between ICU patients and healthy volunteers. EDV may serve as a potential prognostic indicator, and alterations in diastolic flow may reflect early peripheral vascular tension changes. The lack of parameter differences between shock and non-shock ICU patients reveals the physiological limitations of the snuffbox artery RI as a surrogate for systemic vascular resistance.

Critical care medicine is at a pivotal stage of transformation from symptom-based approaches toward systems science. Building on a first-principles understanding of the mechanisms underlying critical illness, we propose the entropic critical illness theory (ECIT). Grounded in the second law of thermodynamics, ECIT posits that critical illness arises when the body’s capacity to regulate entropy production is impaired, leading to systemic disorder. This process is manifested by the concurrent escalation of host response entropy and hemodynamic entropy, resulting in disruptions in blood flow and oxygen delivery, ischemia, and hypoxia at the level of the critical unit, which is defined as the terminal microcirculatory–mitochondrial functional unit, ultimately culminating in multi-organ dysfunction. This study delineates the theoretical foundations of ECIT and outlines an entropy-based critical care framework that may inform future multimodal entropy-informed monitoring, risk stratification, and AI-assisted precision intervention in critical care medicine.

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.

PURPOSE:To assess whether intensive care unit (ICU) transfer delay after ward-onset shock is associated with mortality, and whether early point-of-care ultrasound (POCUS) is associated with outcomes. MATERIALS AND METHODS:Retrospective cohort study using an ICU registry linked to electronic health records at West China Hospital (Jan 1, 2019-Jan 31, 2024). Adults with ward-onset shock requiring first ICU transfer were included. Transfer delay was grouped as <3 h, 3-6 h, or > 6 h. Multivariable logistic regression adjusted for age, APACHE II, and SOFA. Early POCUS was defined as ultrasound within 6 h of shock onset. RESULTS:Among 3535 patients, in-hospital mortality was 24.0%. Mortality increased across delay groups: 18.0% (<3 h; n = 2849), 40.7% (3-6 h; n = 150), and 51.5% (>6 h; n = 536). Versus <3 h, adjusted odds of in-hospital death were higher for 3-6 h (OR 2.34, 95% CI 1.62-3.38) and > 6 h (OR 3.27, 95% CI 2.65-4.03) (both P < 0.001). Early POCUS (n = 251, 7.1%) was associated with lower in-hospital mortality (adjusted OR 0.57, 95% CI 0.37-0.84; P = 0.005) and lower 28-day mortality (adjusted OR 0.47, 95% CI 0.30-0.72; P < 0.001). CONCLUSIONS:ICU transfer delay after ward-onset shock was independently associated with increased mortality, whereas early POCUS was associated with lower mortality.

When the body enters a rapidly progressive and life-threatening pathological state, it is defined as critical illness. At this stage, respiratory and circulatory dysfunction are the most prevalent clinical manifestations. During disease progression and therapeutic interventions, persistent pathological insults, sustained microcirculatory hypoperfusion, and systemic inflammatory responses further contribute to complications such as coagulopathy, acute kidney injury, gastrointestinal dysfunction, and ICU-acquired weakness. Contrast-enhanced ultrasound (CEUS), as a non-invasive and bedside-applicable imaging modality, enables sensitive detection of tissue-level perfusion changes and provides crucial insights for the early identification of organ dysfunction and disease progression. Based on recent advances and our clinical experience, this article focuses on the evaluation and interventional strategies for perfusion-related pathophysiological processes in vulnerable organs within the ICU setting. In particular, we highlight the value of CEUS in assessing hemodynamics in the kidney, gastrointestinal tract, and skeletal muscle, emphasizing its role in microcirculatory monitoring, early disease recognition, CEUS-guided percutaneous interventions, and optimization of thrombus-related therapeutic decision-making. Collectively, these applications could support more precise interventions and have potential to improved patient outcomes.

[This corrects the article DOI: 10.3389/fmed.2025.1665870.].