2023国际重症医学临床研究回顾与展望

Review and prospects of international clinical research in critical care medicine in 2023

2023年国际重症医学的主要临床研究进展包括:中药、羟钴胺(维生素B12)、亚甲蓝和糖皮质激素展示出改善脓毒症与感染性休克结局的潜力;急性呼吸窘迫综合征(ARDS)推出了新的全球定义和治疗指南。此外,在脓毒症补液策略(限制/开放)、抗菌药物输注策略(持续/间断)、机械通气的氧合目标(保守/开放)、院外心搏骤停复苏后的目标血压(高/低)和卒中血管再通后目标血压(强化/常规)、危重症的营养支持治疗(低蛋白-热量/常规蛋白-热量、撤机前禁食/持续喂养)等方面也出现了新的证据。参照以上进展,开展高质量的国内多中心的临床注册研究,建设可共享的重症标准化数据库,提高公众对脓毒症的认识等是提高国内重症医学水平的必由之路。

The main clinical research advances of critical care in 2023 includes:new trials of Chinese herbal medicine,hydroxocobalamin(vitamin B12),methylene blue as well glucocorticoids have shown the potential to improve outcomes of patients with sepsis and septic shock;international committees launched new global definition and managing recommendations for acute respiratory distress syndrome(ARDS).Besides,a cluster of new evidences has emerged in many aspects as following:fluid control strategy in sepsis(restrictive/liberative),antibiotic infusion strategy(continuous/intermittent),oxygen-saturation targets for mechanical ventilation(conservative/liberative),blood pressure targets after resuscitation from out-of-hospital cardiac arrest(hypotension/hypertension),blood pressure targets after successful stroke thrombectomy(intensive/conventional),and nutritional support strategies(low protein-calories/conventional protein-calories,fasting/persistent feeding before extubation).Thus,given above progress,carrying out high-quality domestic multi-center clinical registration researches,constructing shareable standardized databases,as well raising public awareness of sepsis,should be the essential steps to improve our level of intensive care medicine.