This review outlines significant clinical research developments in the field of critical care respiratory medicine from October 2023 to September 2024. In the post-pandemic era, the new global definition of acute respiratory distress syndrome (ARDS) has improved practicality and early warning capabilities, although further refinement through respiratory mechanics and multi-omics approaches is required. Novel patterns of pulmonary microbiota distribution in ARDS patients have emerged, with microbiota-host immune interactions significantly influencing clinical outcomes. Limitations of conventional antiviral and broad-spectrum immunosuppressive therapies have prompted exploration of novel approaches in cell survival regulation and immune maintenance, while modulation of fibroblast phenotypic transformation holds promise for effective repair after severe lung injury. The development of risk prediction tools and machine learning models, which integrate multidimensional bioinformatics data, presents novel opportunities for stratified patient management in critical care and the implementation of intelligent ICU systems. Personalized respiratory support has progressed in the areas of optimal oxygenation targets, positive end-expiratory pressure titration, and extracorporeal membrane oxygenation. While breakthrough therapeutic agents remain elusive, innovations in traditional critical care medication management (vasopressors, sedatives, and proton pump inhibitors) have yielded significant benefits, demonstrating that the field continues to evolve towards more personalized approaches.
本文回顾了2023年10月至2024年9月期间呼吸危重症领域的重要临床研究进展。疫情后时代，急性呼吸窘迫综合征（ARDS）全球定义提高了实用性和早期预警能力，但未来仍需要呼吸力学、多组学技术的进一步完善。ARDS患者肺部微生态分布出现新趋势，微生态与宿主免疫互作影响临床预后。传统抗病毒及广谱免疫抑制药物的局限性促进了细胞存活调节及免疫维持新思路的探索，成纤维细胞表型转化的调节有望给严重肺损伤后的有效修复治疗带来新的契机。综合多维度的生物信息学数据建立的风险预警工具及机器学习模型给危重症患者的分层管理和智慧ICU的建设带来新的契机。个体化呼吸支持在最佳氧合目标、呼气末正压滴定和体外膜氧合方面取得进展。在药物治疗方面，虽然新药物治疗方案未带来突破，但传统重症药物（血管加压药、镇静药物和质子泵抑制剂）管理方式的革新给危重症患者带来了显著获益。.