摘要2019年国际重症医疗实践中有如下趋势呈现：对脓毒症和急性呼吸窘迫综合征（ARDS）表型的分析与验证研究逐渐增多；感染性休克早期应用血管活性药物和抗菌药物的证据增多，也包括对急性肾损伤（AKI）患者的早期呋塞米刺激试验。除此之外，本年度有显著意义的阳性结论的临床研究有：大剂量维生素C治疗感染性休克，压力支持通气（PSV）的撤机策略，氨甲环酸治疗颅脑损伤和新型单克隆抗体治疗埃博拉病毒感染；阴性结论的研究有：中重度ARDS的个体化机械通气、最大化肺复张和肌松联合深度镇静，N95面罩预防流感病毒，机械通气患者的弹性探视制度预防谵妄和右美托咪定用于早期镇静，机械通气患者的日记疗法或复合式预防性心理干预预防创伤后应激障碍（PTSD），重组人可溶性血栓调节蛋白（rhsTM）治疗脓毒症相关性凝血病等。未来的研究重点应以表型分析为突破点，从而确定符合患者病理生理特点和免疫特点的个体化疗法。

abstractsThe following trends emerged in international critical care practice in 2019: increasing analysis to phenotypes of sepsis and acute respiratory distress syndrome (ARDS), increasing evidences of early initiating of vasopressors and antibiotics for septic shock, also including the early furosemide stress test for critically ill patients with acute kidney injury (AKI). In addition, there are many significantly important trials with positive results: high dose vitamin C for septic shock, weaning strategy with pressure support ventilation (PSV) mode, tranexamic acid for patients with acute traumatic brain injury, and new monoclonal antibody for Ebola virus disease. And there are also negatives trials as following: individual mechanical ventilation, maximal recruitment open lung ventilation or early neuromuscular blockade for moderate-to-severe ARDS, N95 respirators preventing influenza, flexible family visit program against delirium or early sedation with dexmedetomidine to mechanically ventilated patients, intensive care unit (ICU) diary or nurse-led preventive psychological intervention against posttraumatic stress disorder (PTSD) in patients with mechanical ventilation, recombinant human soluble thrombomodulin (rhsTM) in patients with sepsis-associated coagulopathy, and so on. Further investigations should be focus on the phenotype analysis, by which individualized management fitting for specific pathophysiologic and immune characters for each patient could be clarified.