[Review and forecast of critical care medicine in 2018]

In 2018, a bunch of considerable positive progresses have been presented, including a revised "hour-1 bundle" introduced by international guideline for management of sepsis and septic shock, trans-pulmonary pressure monitoring via esophageal manometry in acute respiratory distress syndrome (ARDS) models, successful trials for new antibiotics, angiotensin II in patients with vasodilatory shock and renal replacement therapy, advanced airway management in out-of-hospital cardiac arrest (OHCA) patients as well cellular immunotherapy for septic shock. But some of investigational trials did not yield expected results. For example, extracorporeal membrane oxygenation (ECMO) therapy for ARDS patients, the strategy of sequencing weaning with early extubation to noninvasive ventilation, prevention of delirium with haloperidol, surrogate decision supported by interprofessional intensive care unit (ICU) team and prophylaxis for gastrointestinal stress ulceration with pantoprazole in ICU. And more importantly, it has been obvious that the voices and evidences gathered by the opponents against guidelines development, compulsory polices of implementing bundled strategy, market position of hydroxyethyl-starch solutions (HES) and the usage of steroid in septic shock have been largely strengthen, highlighting a more divided and controversial situation.