Guidelines for the construction and management of critical care medicine in China (2025 Edition)

Abstract

Critical care medicine is a clinical medical discipline that studies the pathogenesis, progression, diagnosis, and management of life-threatening diseases caused by various etiological factors. The Intensive Care Unit (ICU), as the core clinical setting of critical care medicine, is responsible for the full-cycle management of critically ill patients, covering a series of comprehensive measures from early warning to rehabilitation. In 2024, the National Health Commission and seven other ministries jointly issued the “Opinions on Strengthening the Capacity Building of Critical Care Medical Services”, promoting the discipline into a new stage of high‑quality development. Based on this, the Chinese Society of Critical Care Medicine (CSCCM) organized domestic experts to discuss and formulate the “Guidelines for the Construction and Management of Critical Care Medicine in China (2025 Edition).” The guidelines focus on core elements of discipline organization and development, covering nine areas: ICU ward construction, ICU admission criteria, staffing and technical requirements for professionals, equipment configuration, quality management, professional training and continuing education, scientific research, response to public health emergencies, and improved service models. The working group initially formed recommended entries through initiation, literature search and screening, and synthesis of medical evidence. The preliminary recommendations were then revised through expert panel reviews, remote and face-to-face meetings, revisions, and finally finalized by voting at the Standing Committee of CSCCM, resulting in the establishment of foundational and developmental discipline construction guidelines. The guidelines apply to ICUs in secondary and above healthcare institutions, providing a scientific framework for discipline planning, construction, and management to enhance the quality of critical care services.

Practice guideline registration: Practice Guideline Registration for Transparency (PREPARE-2025CN972).

Introduction

Critical care medicine (CCM) is a clinical medical discipline that studies the pathogenesis, progression, diagnosis, and management of life-threatening diseases. The intensive care unit (ICU) serves as the clinical base for CCM, responsible for implementing comprehensive management throughout the entire treatment cycle of critically ill patients, covering a series of integrated measures from early warning to rehabilitation. The ability to manage critically ill patients directly reflects the comprehensive diagnostic and therapeutic capabilities of a hospital and is an important indicator of modern hospitals. The development and management of this discipline must follow relevant national policies and regulations.^[1] CCM in China has remarkably progressed over the past 40 years, particularly after withstanding major public health emergencies such as the SARS outbreak, the Wenchuan earthquake, and the COVID-19 pandemic. With the support of national policies, it has experienced rapid development in the past 20 years. In 2024, the National Health Commission of China and seven other ministries jointly issued the “Opinions on Strengthening the Capacity Building of Critical Care Medical Services”,^[2] marking that CCM in China has entered a new development stage.

Based on national “Healthy China” strategy and important policy documents such as “Opinions on Strengthening the Capacity Building of Critical Care Medical Services”,^[2] while referring to international guidelines and combining actual situation in China, the Chinese Medical Association-Chinese Society of Critical Care Medicine (CSCCM) has formulated the “Guidelines for the Construction and Management of Critical Care Medicine in China (2025 Edition)”. The guideline aims to promote the continuous and long-term development of CCM in China, further systematically standardizing the construction standards and developmental pathways of the discipline. Its scope covers the planning, design, implementation, and management of ICUs in secondary and above healthcare institutions. This guideline establishes a standardized framework while accommodating the diverse requirements of medical institutions across different levels and regions. It maintains flexibility in certain provisions to allow institutions to develop implementation details tailored to their specific circumstances. The core principles are explicitly defined to ensure authoritative guidance, with key clauses providing definitive operational direction. The guidelines will be dynamically updated and revised in response to evolving disciplinary developments.

Methodology for the Guideline Development

Guideline positioning

The guidelines are positioned as management guidance for discipline construction, focusing on the standardization of the management framework for discipline construction, and emphasizing the dynamic balance between policy effectiveness and clinical practice.

Organization and evidence integration

A writing group comprising 23 experts was formed, all meeting the selection criteria: at least 15 years of experience in CCM, holding ICU management positions in provincial-level or above hospitals, and leadership of provincial or ministerial research projects within the past 5 years. The selection process ensured balanced regional representation across China. Evidence was integrated using the PIECES framework, with searched databases including PubMed, Embase, Ovid, Cochrane, Web of Science, Wanfang, CNKI, VIP, and the official website of the People's Republic of China. The search period spanned January 1990 to June 2024, with publications restricted to Chinese and English. A systematic retrieval was performed for six dimensions: policy documents (issued by the National Health Commission), infrastructure standards, education and training systems, clinical governance, equipment standards, and service models. Then, an evidence-based grading framework was developed, including grade A (policy documents and international standards), grade B (multicenter management data), and grade C evidence (expert consensus and clinical experience).

Formulation of structured proposals

A steering committee of 40 experts was established, all meeting the selection criteria, including provincial-level ICU management experience or tertiary hospitals director qualifications, with balanced regional representation across China. The process was implemented using a modified Delphi methodology. The writing group developed a preliminary evidence-based draft. The first round was an in-person discussion by 27 panel members. The second round comprised a hybrid online-offline review by all 40 experts. The third round involved a postal review by the experts. The final version was approved by a two-thirds majority vote of the Standing Committee of the CSCCM.

Criteria for guidelines updating

A dynamic revision mechanism was established for the guidelines. An update process will be initiated upon meeting any of the following conditions: (1) policy driven: the National Health Commission releases major policy adjustments in the field of CCM; (2) technological innovation: breakthrough advancements in life-supporting technologies or intelligent medical devices; (3) event response: deficiencies in existing construction standards exposed by new major public health events; (4) evidence accumulation: high-quality management studies demonstrating systematic bias in current provisions; (5) implementation feedback: >30% of secondary and tertiary hospitals proposing similar revision suggestions during annual quality evaluations.

Target audience and scope

The guidelines apply to ICUs of secondary and higher-level healthcare institutions, providing a scientific framework to guide planning, construction, and management of these units, thereby improving the level of critical care.

Dissemination and implementation

The guidelines will be implemented through a multi-dimensional promotion strategy: full-text publications will be released, on the society’s official website, WeChat official account, and authoritative journals, accompanied by expert interpretation videos; dedicated sessions on the guidelines will be organized at academic conferences and specialized alliance meetings to provide in-depth interpretation through thematic lectures; leveraging initiatives such as the “Thousand Counties Project” and “Critical Care in Primary Healthcare”, targeted support for discipline development will be provided, offering context-specific recommendations to enhance standardized critical care services.

Design and Construction of ICU

ICU bed allocation and facility setup by hospital tier

Independent ICUs should be established in secondary and higher-level general hospitals, specialty hospitals, pediatric hospitals, and eligible Traditional Chinese Medicine (TCM) institutions (including integrated Chinese and Western medicine hospitals and ethnic minority hospitals). Secondary hospitals must possess the capacity to treat severe patients, with equipping monitoring systems, life support devices, and specialized personnel for common critical illnesses within their regions. Tertiary hospitals should demonstrate comprehensive capabilities in diagnosing and managing complex, rare, and severe cases, mastering all advanced technologies in critical care. Following the “routine-emergency integration” principle, hospitals should reserve convertible ICU beds in designated independent wards or buildings. These beds must meet infection control standards and be equipped with oxygen and power supply systems as well as life support equipment to enable the conversion into fully functional ICU beds within 24 h.^[2] According to national requirements, tertiary general hospitals, TCM hospitals, infectious disease and pediatric specialty hospitals must ensure that both comprehensive and convertible ICU beds account for ≥4.5% of total hospital beds. This proportion must be ≥2.4% in secondary general hospitals, as well as in infectious disease and pediatric specialty hospitals.^[2] These ratios should be gradually increased according to hospital development and patient needs.

The number of ICU beds should align with hospital functions, service capacity, and actual patient admission needs, while also accommodating emergency treatment for severe cases during public health emergencies. The ICU bed occupancy rate should ideally be maintained at 75%, with expansion considered if the annual average occupancy exceeds 85%. At least one bed should be kept available daily for emergencies.^[1] Large teaching hospitals, medical university-affiliated hospitals, and provincial tertiary hospitals should also possess appropriate teaching and research capabilities. They must have an independently dedicated teaching area with specialized facilities, including multimedia classrooms, clinical skills training and assessment facilities, and simulation teaching equipment.

Unlike general hospitals, specialty hospitals focus on treating more specialized conditions while maintaining comprehensive medical capabilities. Therefore, the ICU in specialty hospitals should be responsible for resuscitation and critical care for critically ill patients within these hospitals. These hospitals should establish specialized critical care teams and enhance their capacity to treat specialty-specific critically ill patients. Secondary and higher-level specialty hospitals should determine the number of ICU beds based on actual needs.^[1]

Layout and design of ICU

Hospitals should strategically plan ICU layouts based on their scale and departmental configurations. The overall design must balance routine operations and emergency response capabilities for public health crises, ensuring efficient conversion of “peacetime-emergency integration”. Institutions with adequate resources may establish independent sub-ICU wards according to ICU bed capacity and critical patient volume.^[3]

ICU planning and layout

ICUs should be located near key medical service areas (e.g., operating rooms, imaging departments, and blood banks) to facilitate rapid patient transfer and timely access to diagnostic and therapeutic measures. ICU layouts must comply with hospital infection control standards by designing rational workflow pathways, including personnel and material flows, with standardized separate access routes for medical staff, patients, medical supplies, and waste disposal.

The overall ICU layout should be divided into medical and auxiliary functional zones. Medical zones include patient rooms, central workstations, medication preparation rooms, equipment storage, point-of-care testing (POCT) labs, linen rooms, and family reception areas. Facilities involved in clinical trials must adhere to Good Clinical Practice (GCP) guidelines. Auxiliary zones comprise administrative, residential, and dedicated waste disposal areas, with each being relatively independent to minimize cross-contamination risks. The administrative area consists of the physicians’ offices, the department head’s office, the nurses’ office, and teaching rooms. The residential area includes a staff lounge, locker room, on-call room, and lavatory. The dedicated waste disposal area is primarily used for centralized medical waste handling. Facilities may also include clinical research, sample handling, and storage rooms. The number and size of functional areas should be based on practical needs such as ICU bed capacity and staff size. The ratio of the auxiliary space to patient room area should generally exceed 1:1.

The ICU interior decoration

ICU interior decoration should facilitate cleaning, prevent dust generation and accumulation, while featuring corrosion resistance, moisture/mold resistance, anti-static properties, and fireproofing. The dimensions of ICU corridors should meet the requirements for the rapid and safe passage of patients, beds, equipment, and medical staff during emergencies. Visual transparency between bed units and the central workstation is recommended to facilitate observation. Semi-glass partitions may be adopted between bed units. When possible, single- and multi-bed rooms should be rationally configured and equipped with bedside monitoring, central and remote monitoring systems, electronic communication devices, secondary alarm systems, and privacy protection devices.^[3]

ICU interior design should fully utilize natural lighting and ventilation conditions, which are important to the health of both patients and staff.^[4] This helps alleviate patient stress, decrease analgesic use, improve sleep quality,^[5] and reduce the incidence of psychological issues.^[6] Air purification systems may be installed where feasible to maintain indoor air quality, with adjustable purification levels as needed, while ensuring the retention of natural ventilation capability. Each bed unit should be configured in a “island configuration” mode, with independent control switches for electrical and gas circuits. Medical power supply and general lighting circuits should be routed separately.

ICU bed unit configuration

Bed unit design should reserve adequate space to accommodate bedside treatment equipment, such as portable ultrasound machines, electrocardiographs, blood purification devices, and extracorporeal life support systems. Single rooms should have a usable area of 18–25 m², with a minimum 1.2 m clearance between the bed head/foot and the wall, and at least 1.8 m clearance between both bed sides and the wall.^[7,8] Multi-bed rooms should have the average usable area of ≥15 m² per bed, with a minimum 2.5 m spacing between beds.^[9] Single rooms offer advantages in reducing cross-infection, protecting privacy, and enhancing sleep quality.^[10] Hence, it is recommended to prioritize single rooms or partitioned bed layouts.

ICUs should be equipped with 1–2 negative-pressure bed units. Tertiary hospitals and those with adequate resources may establish additional negative-pressure bed units in their ICUs to meet the requirements for treating severe infectious diseases. ICUs must provide sufficient non-contact handwashing facilities and hand sanitizer dispensers, one set per bed in single rooms and at least one set for every two beds in open wards, with other functional areas as needed.

Sub-ICU layout and bed allocation

Sub-ICU is a transitional care unit with intermediate capacity between ICU and general wards. It serves critically ill patients who do not require advanced life support (e.g., extracorporeal membrane oxygenation [ECMO], continuous renal replacement therapy [CRRT]) but still require intermediate monitoring (e.g., electrocardiogram [ECG], high-flow oxygen therapy, noninvasive ventilation, or intermittent hemodialysis), as well as those requiring prolonged invasive ventilation or difficult weaning. The sub-ICU establishment increases critical care bed capacity and ensures timely ICU admission for more complex cases, thereby reducing post-ICU discharge mortality.^[11,12] Sub-ICU is recommended to be an independent unit adjacent to or near the ICU.^[13]

The layout of the sub-ICU should follow the medical and auxiliary ICU zoning principles. A dedicated testing room equipped with POCT devices (e.g., blood gas analyzers) is essential. The number and size of functional rooms should be determined based on sub-ICU bed capacity and staff numbers. For large-scale ICUs with 22–28 beds, the number of sub-ICU beds may be adjusted according to clinical demands but should generally not exceed 50% of the ICU total beds.^[14,15] Single-room area, multi-bed spacing, non-contact handwashing facilities, and sanitizer dispensers must comply with ICU infection control standards. Furthermore, sub-ICUs generally do not require negative-pressure rooms.^[15]

Convertible ICU bed layout and design

When renovating convertible wards, sufficient usable space should be considered to facilitate easy ward clearance and conversion when needed. The renovation requires rational layout planning, with advanced design addressing functional zoning for ICU conversion and infection control requirements. During conversion, POCT devices (e.g., blood gas analyzers) may be deployed from central laboratories or installed in ward equipment rooms.^[9,16] Convertible ward beds should maintain standard ward layouts during regular use, while post-conversion configurations can meet ICU bed unit requirements, potentially adopting decentralized workstations or partitioned layouts.^[9] Equipment configurations for convertible ICU beds should align with ICU standards. Renovation projects must ensure all oxygen supply, gas supply, negative pressure suction, and power interfaces within the ward match ICU and sub-ICU standards, guaranteeing unified support for ventilators and related equipment across the hospital.^[9,16]

Critical care informatization requirements

With advancements in medical technology, the demand for informationization of critical care is increasing. The intelligent critical care information management systems (CIMS) play a key role in promoting the development of medical treatment, teaching, and scientific research in critical care medicine. This initiative standardizes and optimizes ICU clinical workflows by enabling information integration and multidimensional queries, statistics, and analysis. It establishes closed-loop management for clinical treatment and quality control processes, thereby enhancing ICU operational efficiency and medical quality. As a crucial measure for improving critical care rescue capabilities, it constitutes an important component of modern hospital construction and management.^[[17], [18], [19], [20], [21]^]

Core requirements for CIMS

The system should integrate Hospital Information System, Electronic Medical Record System, Laboratory Information System, and Picture Archiving and Communication System to ensure full patient information coverage. Additionally, it should incorporate Computerized Physician Order Entry and Electronic Nursing Records to document medical and nursing activities.^[21,22]

Advanced objectives for CIMS (where feasible)^[17,18]

Where feasible, the system will be further developed based on fundamental requirements to achieve (but not limited to) the following objectives:

(1) Automated Data Capture and Processing: ① Internet of Things (IoT)-based automatic collection: including vital signs from monitors, hemodynamic monitoring parameters, ventilator settings, hemodialysis parameters, infusion pump/infusion line medication and flow rate data, with future upgrade and expansion capabilities; ② Automated critical care scoring systems: encompassing APACHE II, SOFA, sedation/pain management, thrombosis/bleeding risk, and nutritional assessments; ③ Intelligent nursing information systems: featuring automated capture of vital signs, fluid intake/output, vascular access records, medications, and events.

(2) Data Integration and Multi-Dimensional Analytics: By consolidating data from various information systems, we can comprehensively analyze patient data trends and changes across multiple dimensions. Centered on critical care models such as quantitative assessment, early intervention, and titrated therapy, this approach leverages artificial intelligence (AI) technologies, including machine learning and deep learning, combined with 5 G communication technology to establish tailored rule bases and algorithm libraries. The resulting data platform enables real-time processing, structured data presentation, and intelligent early warning systems, driving precision medicine forward.

(3) Quality Control and Performance Management: By leveraging digital technologies, this system automates quality control data collection and reporting, implements process quality control and closed-loop management for key diseases, and promotes standardized ICU workflow development to achieve uniform medical care. It also enables automated extraction and analysis of clinical data—including ICU disease categories, Case Mix Index, workload, and cost ratios—to facilitate scientific and refined management.

(4) Specialized Disease, Research Databases, and Clinical Research Support Platforms: Structured, standardized data storage allows for automated disease identification, data capture, analytics, and intelligent research support, enhancing clinical study quality and efficiency.

ICU Admission Criteria

ICU admission criteria generally include (1) patients with acute, reversible, life-threatening organ or systemic dysfunction or failure, who may recover within a short period through intensive monitoring and treatment; (2) patients with high-risk factors and potential life-threatening conditions, whose risk of death may be reduced through intensive monitoring and treatment; (3) patients with chronic organ or systemic insufficiency who experience acute, life-threatening exacerbations and may return to their baseline or near-baseline status through intensive monitoring and treatment; (4) other patients suitable for ICU monitoring and treatment.

Patients with chronic wasting diseases, irreversible conditions, or those unlikely to benefit from intensive monitoring and treatment are generally not considered suitable for ICU admission.

Staffing and Technical Requirements for CCM

The sustainable advancement of CCM depends on a highly qualified workforce, including physicians, nurses, and technicians. Institutions should ensure that these professionals acquire comprehensive theoretical knowledge and practical expertise, as well as maintain their competencies through structured training programs and standardized certification systems.

Qualifications and competencies of intensivists

Intensivists must undergo systematic professional training in CCM, acquire comprehensive theoretical knowledge and clinical skills, and successfully pass a formal qualification examination. Only those who meet the following conditions can be recognized as qualified for an intensivist's appointment: (1) Hold a Standardized Residency Training (SRT) Qualification Certificate in CCM, the nationally mandated structured postgraduate training program for resident physicians in China, with registration by the local health authority according to the Administrative Measures for Physician Practice Registration. (2) Physicians without prior SRT in CCM who transfer to work in the ICU must work or undergo training in the ICU for at least 2 years according to national regulations. After passing the training, the local health authority shall change its practice scope in accordance with the Administrative Measures for Physician Practice Registration. (3) ICU directors should hold the title of Associate Chief Physician or above in CCM. (4) Chief nurses in ICUs should hold at least an intermediate-level professional qualification and possess provincial-level or higher critical care specialist nurse certification.

Theoretical and technical requirements for intensivists

Intensivists are required to master the basic core competencies of the specialty to meet the diagnostic and therapeutic needs across different levels of care. In secondary and tertiary hospitals with adequate resources, intensivists should further develop proficiency in advanced techniques corresponding to the institution’s clinical capacity. Facilities meeting the necessary standards and accreditation may additionally undertake highly specialized technologies (regulated/restricted access).

Clinical theoretical knowledge requirements

Cardiopulmonary resuscitation (CPR); shock; respiratory failure; heart failure and life-threatening arrhythmias; acute kidney injury; central nervous system dysfunction; acute liver failure; gastrointestinal dysfunction and major gastrointestinal bleeding; acute coagulation disorders; severe endocrine and metabolic disturbances; fluid, electrolyte, and acid-base balance disorders; enteral and parenteral nutrition support; sedation and analgesia; severe infections (sepsis); multiple organ dysfunction syndrome; immune dysregulation in critical illness; ICU-relevant clinical pharmacology; early recognition and prevention of critical illness; and critical care rehabilitation.

Basic technical requirements

(1) Essential monitoring: continuous vital signs; respiratory mechanics; noninvasive and invasive arterial blood pressure; central venous pressure; intra-abdominal and bladder pressure; illness severity and multi-organ function; sedation, analgesia, and delirium; and nutritional status evaluation). (2) Basic life support: CPR; electrical cardioversion and defibrillation; endotracheal intubation; invasive and noninvasive mechanical ventilation; conventional and high-flow oxygen therapy; prone positioning ventilation; central venous and arterial catheterization; thoracentesis and closed chest tube drainage; abdominal paracentesis; lumbar puncture; bone marrow aspiration; and sedation and analgesia.

Advanced technical requirements

Intensivists in tertiary hospitals and secondary hospitals with adequate resources should master the following advanced techniques: invasive hemodynamic monitoring (including transpulmonary thermodilution, pulmonary artery catheterization, and pulse contour analysis); bedside critical care ultrasonography for cardiovascular, pulmonary, and abdominal evaluation; tissue and cerebral oxygen saturation monitoring; percutaneous tracheostomy; bronchoscopy for airway inspection, bronchoalveolar lavage, foreign body retrieval, and intrabronchial drug administration; bedside extracorporeal blood purification therapy, including hemodialysis, hemofiltration, plasma exchange, hemoperfusion, intra-aortic balloon pump (IABP), and ultrasound-guided vascular and procedural access techniques.

Highly specialized technologies

Intensivists may also undertake highly specialized techniques in institutions with the necessary resources and accreditation. These include extracorporeal membrane oxygenation (ECMO) and ventricular assist devices, such as Impella systems and left ventricular assist devices.

Depending on departmental technical capabilities and clinical requirements, additional specialized techniques can be implemented, including advanced respiratory function monitoring (functional residual capacity measurement, dead space estimation, esophageal and transdiaphragmatic pressure monitoring, diaphragmatic electromyography, and electrical impedance tomography [EIT]), energy metabolic monitoring, bedside temporary cardiac pacing, extracorporeal carbon dioxide removal (ECCO₂R), extracorporeal cardiopulmonary resuscitation, intravascular temperature management, invasive intracranial pressure monitoring, transcranial Doppler assessment of cerebral blood flow, advanced neurological monitoring (multimodal, continuous, and quantitative electroencephalography), lumbar cisternal drainage, and percutaneous endoscopic gastrostomy or jejunostomy.

Roles and responsibilities in CCM

Resident physicians

Resident physicians, supervised by attending physicians, take full responsibility for the management of critically ill patients. Their duties include assessing illness severity, implementing diagnostic and therapeutic plans, coordinating patient examinations and transfers, and ensuring effective communication with families for informed consent. Strict adherence to institutional protocols and documentation standards is mandatory. Residents must establish a solid foundation in critical care knowledge, achieve proficiency in basic procedures, and progressively acquire advanced skills. Competence in operating life-supporting and monitoring equipment is also expected. Additional responsibilities include participation in teaching activities for interns and medical students, as well as involvement in research and quality-improvement initiatives under the guidance of senior physicians.

Attending physicians

Under the leadership of the Chief (Associate Chief) Physician, the attending physicians take primary responsibility for patient care within their service group. Such responsibilities encompass daily ward rounds, dynamic monitoring clinical progress, adjusting treatment strategies, and guiding residents during the evaluation and management of organ dysfunction. Proficiency in advanced critical care techniques is required, with continued advancement in highly specialized procedures encouraged as dictated by clinical needs. Additionally, they assist senior physicians in critical care resuscitation, participate in discussions of complex/critical cases, and conduct dead case reviews. Attending physicians are also responsible for teaching residents, fellows, and postgraduate trainees, as well as contributing to departmental research activities.

Associate chief and chief physicians

Associate chief and chief physicians are senior-level clinical, educational, and research leaders. Their responsibilities include comprehensive assessment of critically ill patients, formulation of individualized treatment strategies, and assurance of effective implementation. Leadership in resuscitation of life-threatening conditions and organization of multidisciplinary case conferences are essential. They must show mastery of highly specialized ICU techniques, along with the active promotion of new technologies and practices. Supervising teaching at all levels and defining departmental academic and research priorities are key components of this role. Continuous engagement with international advances in CCM is expected to sustain scholarly and clinical leadership.

ICU director

The director is fully responsible for the work of the department, covering the construction of the discipline, medical services, administrative management, teaching, and research to ensure efficient operation and sustainable development of the discipline.

(1) Discipline development: Strategic plans must be developed in alignment with the hospital’s mission, institutional capacity, and clinical demand. Related responsibilities include advancing subspecialty development, creating structured pathways for talent training, and establishing national-level training and academic programs in tertiary and teaching hospitals. Developing research platforms and clinical trial bases for drugs and medical devices is also required.

(2) Administrative management: The director must be fully accountable for departmental operations, including oversight of personnel management, equipment utilization, infection prevention and control, performance evaluation, and medication management. Coordination with other clinical and technical departments must be maintained to ensure efficiency and optimal resource allocation.

(3) Clinical management: Patient safety and quality of care must be ensured by establishing, implementing, and supervising evidence-based treatment standards. Relevant responsibilities include leading multidisciplinary collaboration, integrating institutional resources, and directing the management of critically ill patients. During public health emergencies, rapid expansion of ICU capacity, deployment of convertible ICU models, and organization of emergency medical teams are essential to ensure response capability.

(4) Teaching management: Educational activities within the department must be developed and sustained at a high level. Tertiary and teaching hospitals must obtain accreditation as residency and fellowship training bases, as well as postgraduate education programs. The director serves as a training base leader and postgraduate supervisor, overseeing educational project applications, promoting innovative teaching methods, and ensuring the translation of educational outcomes into practice.

(5) Research management: Furthermore, academic leadership includes the coordination of the departmental research agenda, initiating grant applications, supervising research implementation, and promoting knowledge translation. Leading national and provincial-level project applications in tertiary and teaching hospitals are required to enhance the academic influence and international reputation of CCM.

ICU staffing by hospital tier

The intensivist workforce should include senior, intermediate, and junior physicians. Each management unit should be led by one senior intensivist with overall responsibility for clinical care. Routine staffing may include residents and subspecialty fellows on rotation, as well as visiting physicians. Nurse staffing should match the intensity of treatment required.^[23,24]

Patients with two or more acute organ dysfunctions who require supportive therapies, such as hemodynamic support, mechanical ventilation, or continuous renal replacement therapy, need one-to-one nurse staffing. One nurse may manage up to three high-risk patients without acute organ dysfunction.^[25]

Secondary hospitals (Tier II)

The recommended physician-to-bed ratio is ≥0.8:1, while the nurse-to-bed ratio should be ≥2:1. As applicable, respiratory therapists and rehabilitation therapists should be included. Units with >12 beds should consider forming care teams, including at least one attending physician.

Tertiary hospitals (Tier III)

The recommended physician-to-bed ratio is ≥0.8:1, whereas the nurse-to-bed ratio should be 2.5–3.0:1. Respiratory and rehabilitation therapists should be allocated according to subspecialty requirements. Where conditions permit, institutions are encouraged to establish a multidisciplinary team (MDT) for critical illness, including dietitians, clinical pharmacists, and other relevant professionals.

Staffing and technical requirements for sub-ICU

Physicians

Sub-ICUs should be staffed with intensivists, maintaining a physician-to-bed ratio of 0.4:1. Appointing one senior intensivist is advisable. Rehabilitation therapists may also be included. Where feasible, a rehabilitation MDT (e.g., comprising dietitians and rehabilitation therapists) may be established. Family caregivers may assist with rehabilitation.

Nurses

Nurses should master the basic theory of intensive care, basic nursing skills, and the rescue ability of critical patients, and be able to provide continuous nursing needs such as monitoring, treatment, rehabilitation, and patient education. The nurse-to-bed ratio should be set at ≥1:1.

Staffing and technical requirements for convertible ICU beds

Convertible ICU beds are set to provide available ICU beds during major emergencies or periods of limited medical resources.^[13] Under routine conditions, physician and nursing allocations should follow general ward standards. Once converted for ICU use, the unit should fall under full management according to and be taken over by the CCM department.

Staffing and technical requirements for respiratory therapists and rehabilitation therapists

ICUs with sufficient resources are encouraged to allocate an appropriate number of respiratory and rehabilitation therapists as needed.

Respiratory therapists should monitor, manage, and treat patients with respiratory dysfunction, operate respiratory support equipment proficiently, perform essential airway management, and provide respiratory rehabilitation and aerosol therapy.

Rehabilitation therapists should be trained in common rehabilitation techniques, skilled in functional rehabilitation theory and practice, and proficient in rehabilitation assessment and treatment.

Technical requirements for critical care nursing staff

ICU nurses must complete structured professional training and acquire competency in both the theoretical foundations and practical skills of critical care nursing. Independent practice should be permitted after completing a formal departmental evaluation and certification.

Besides routine clinical nursing, ICU nurses should be competent in critical patient assessment, basic care, organ support, and emergency procedures. These include operating monitoring systems, ventilators, infusion and syringe pumps; assisting with defibrillation and airway management; monitoring organ function, fluids, electrolytes, and acid-base balance; providing nutritional support; preventing hospital-acquired infections; and maintaining catheters. Mastery of these skills allows nurses to deliver systematic and precise care, ensuring better outcomes for critically ill patients.

ICUs are encouraged to nominate nursing staff for specialized training in advanced areas, such as blood purification, ECMO, critical care ultrasonography, and critical care rehabilitation, to strengthen specialty nursing capacity. Furthermore, ICU nurses should prioritize effective communication with patients and their families, including continuous improvement of communication skills, application of evidence-based communication strategies, timely information sharing, bridging of knowledge gaps, and provision of emotional support. Such communication helps families better understand the patient’s condition and nursing care.

Development of the intensivist workforce

Building a strong intensivist workforce is essential for improving the treatment of critically ill patients and responding to major public health emergencies. As a key platform discipline, critical care training should support the development of other specialties and multidisciplinary collaboration. A balanced system of training in clinical care, education, and research is recommended, combining local development with international exchange and supported by adequate resources and programs. Training should include specific research priorities, strengthen foundations, and cultivate high-level talent with international competitiveness.

To strengthen the development of high-level talent, university-affiliated and tertiary hospitals should focus on the frontiers of critical care, making use of national projects, laboratory platforms, and talent programs to develop nationally and provincially recognized experts. Efforts should be directed toward building globally influential teams of CCM leaders through overseas training, academic exchange, and project funding.

To optimize international talent recruitment, high-level ICU platforms should enhance collaboration with leading universities and research groups worldwide to attract outstanding young researchers. They should establish innovation platforms, expert studios, and joint laboratories with overseas institutions, gradually building an international talent pool in critical care to support national scientific advancement.

Development of critical care subspecialties

Developing critical care subspecialties optimizes resource allocation and improves efficiency and quality of care. Attending physicians and higher-rank specialists are encouraged to pursue subspecialty training according to institutional and disciplinary needs. Areas such as respiratory, cardiovascular, and neurocritical care should be prioritized, with gradual expansion into other fields.

Training should cover clinical care, education, and research, including subspecialty techniques, teaching curricula, and both basic and clinical research capacity, to ensure high-level competence. Establishing a subspecialty-specific quality control system is recommended to regularly assess care quality, patient outcomes, and complication rates, thereby ensuring safety and continuous improvement.

ICU Equipment Configuration

ICU equipment configuration requirements by hospital tier

ICU equipment configuration for secondary general hospitals

The ICU equipment configuration for secondary general hospitals should include the following items: (1) An uninterruptible power supply (UPS) system, with a power capacity sufficient to meet the emergency needs of ward lighting and medical equipment for at least 1 h; (2) Beds equipped with a comprehensive functional equipment rail or rack. Each hospital bed should be provided with ≥12 power outlets and two interfaces each for oxygen, compressed air, and negative pressure suction, to ensure functional support for electricity, medical oxygen, compressed air, and negative pressure suction; (3) Hospital beds suitable for ICU use, along with anti-decubitus mattresses; (4) Monitoring equipment. Each bed should be equipped with a bedside monitoring system capable of ECG monitoring, blood pressure monitoring, pulse oximetry, and invasive pressure monitoring; (5) Respiratory support equipment. Each bed should have a manual resuscitator (bag-valve-mask). An appropriate number of ventilators and portable ventilators may be installed based on actual needs; (6) Infusion equipment. Each bed should be equipped with an infusion pump and micro-infusion pumps. Each bed should have ≥4 micro-infusion pumps, along with an appropriate number of enteral nutrition infusion pumps; (7) Blood purification devices. An appropriate number of blood purification devices may be installed according to actual needs; (8) Other essential equipment, consisting of an electrocardiograph, blood gas analyzer, defibrillator, CPR rescue cart, and therapeutic hypothermia/normothermia devices.

ICU equipment configuration for tertiary hospitals

The ICU equipment configuration for tertiary general hospitals should be comprehensive, specifically the following: (1) A UPS system with a sufficient power capacity to meet the emergency needs of ward lighting and medical equipment for at least 1 h; (2) Beds with a comprehensive functional equipment rail or rack. Each hospital bed should be provided with ≥18 power outlets, six wired data transmission ports, and two interfaces each for oxygen, compressed air, and negative pressure suction, thereby ensuring functional support for electricity, medical oxygen, compressed air, and negative pressure suction; (3) Hospital beds suitable for ICU use, along with anti-decubitus mattresses; (4) Monitoring equipment. A central monitoring system should be equipped in the ward area. Each bed should have a bedside monitoring system for monitoring basic vital signs, ECG, blood pressure, pulse oximetry, and invasive pressure. Pulse indicator continuous cardiac output monitors should be installed as needed. Each ICU ward should be equipped with at least 1 portable monitor to facilitate the safe transfer of patients; (5) Respiratory support equipment. A sufficient number of invasive ventilators should be installed based on demand. Each ICU ward should be additionally equipped with at least 1–2 conventional ventilators for backup use. A manual resuscitator (bag-valve-mask) should be installed for each bed. Up to two portable ventilators should be provided for every 20 beds to facilitate the safe transfer of patients. High-flow nasal cannula (HFNC) oxygen therapy devices and noninvasive ventilators should also be installed as needed; (6) Beds with an infusion pump, ≥4 micro-infusion pumps, and an enteral nutrition infusion pump; (7) Blood purification devices as needed; (8) A sufficient number of mobile ultrasound machines; (9) A sufficient number of bronchoscopes according to the number of beds. Where feasible, ICUs may be equipped with disposable electronic bronchoscope systems and an adequate supply of consumables (for special patients); (10) ECMO. ICUs with the required qualifications should be equipped with ECMO devices based on the bed demand and activated clotting time detectors to meet clinical use requirements; (11) Other equipment. The specific quantity of equipment such as electrocardiographs, blood gas analyzers, defibrillators, continuous hemodynamic monitoring equipment, CPR rescue carts (equipped with video laryngoscopes, endotracheal tubes, cricothyrotomy kits, various connectors, emergency drugs, and other rescue tools), temporary external pacemakers, airway clearance devices, therapeutic hypothermia/normothermia devices, mobile X-ray machines, and pneumatic compression pumps for thrombosis prevention should be provided based on clinical requirements; (12) Additional equipment. Qualified institutions with the necessary capabilities are recommended to be equipped with intracranial pressure monitoring devices, EEG monitoring devices, cerebral oxygen monitoring devices, IABP devices, ECCO₂R devices, sublingual microcirculation monitoring devices, POCT devices (for detecting myocardial enzymes, coagulation function, inflammatory factors, acute kidney injury markers, etc.), and ventilator internal circuit disinfection machines.

Equipment configuration requirements for sub-ICU

The equipment configuration for sub-ICU should refer to the ICU standards, mainly including the following: (1) Monitoring equipment. A standard monitor should be installed for each bed, as well as portable monitors; (2) Respiratory support equipment. Necessary ventilators and manual resuscitators should be installed for each bed; (3) Infusion equipment. Each bed should be equipped with infusion and micro-infusion pumps; (4) Rehabilitation-related equipment, such as patient transfer devices, bedside exercise bikes, walking aids, and limb function trainers; (5) Portable oxygen supply devices; (6) Other essential equipment, including an electrocardiograph, multi-functional defibrillator, blood gas analyzer, enteral nutrition pump, electric suction device, CPR rescue cart, and therapeutic hypothermia/normothermia devices.

Equipment configuration requirements for convertible ICU bed units

Convertible ICU bed units should function as ICU beds, with their equipment configuration following the ICU standards. Specifically, the equipment configuration requirements for convertible ICU bed units include the following: (1) Oxygen source. The hospital should be equipped with a dual-channel oxygen supply system to ensure the continuous supply of oxygen under any circumstances. The calculation of the medical oxygen source flow rate should be based on the patient’s needs and comprehensively consider the maximum oxygen flow rate required when using equipment such as invasive ventilators, noninvasive ventilators, and HFNC oxygen therapy devices. The recommended flow rate for each high-flow oxygen delivery terminal is 40–60 L/min. The recommended simultaneous usage coefficient for oxygen terminals in convertible ICUs is 40; (2) The air supply is capable of providing compressed air; (3) Power supply. Dual-channel and emergency power supplies should be installed to ensure the normal operation of equipment under any circumstances. Each bed should be equipped with at least 12 power outlets; (4) Universal equipment interfaces. Each bed should be installed with ICU-standard oxygen interfaces, compressed air interfaces, and two negative pressure suction interfaces. The oxygen supply, air supply, power supply, suction equipment, and interfaces should all meet ICU requirements to ensure safe and convenient equipment connection.

Quality Management

Medical quality and safety represent the core components of the Healthy China initiative, being essential to the high-quality development of healthcare services. Quality control in CCM is vital to build a high-quality and efficient healthcare service system and safeguard people’s lives and health (the Quality Control Indicators for Critical Care Medicine in Supplementary material).^[26]

Establishment of medical quality management systems

ICUs should implement quality management standards and quality control indicator systems mandated by health authorities at all levels and their affiliated hospitals. Establishing and improving comprehensive regulations, job responsibilities, technical standards, and operational procedures are recommended. Annual quality control implementation plans and improvement programs should be developed based on local conditions, with regular audits and revisions to ensure compliance. These will promote the high-quality development of ICUs. Each ICU should establish a medical quality management team, in which the department director serves as the principal person responsible for quality management.

Collection and reporting of quality control Indicators

ICUs should implement principal quality management and self-assessments according to quality control indicators and monitoring standards related to key technologies and major conditions in CCM. Medical quality management tools and digital platforms should be fully utilized to collect indicators related to patient safety and quality of care, thereby forming a foundation of institutional quality data. ICUs must report quality control data accurately and promptly to the relevant health authorities as required.

Continuous improvement of medical quality

ICUs should regularly evaluate compliance with quality management requirements, analyze and provide feedback on collected quality data, and establish goal-oriented, refined strategies for continuous quality improvement. Assessing the effectiveness of these interventions is also needed to ensure continuous enhancement of medical quality.

Professional Training and Continuing Education

Standardized residency training in CCM

Resident physicians in Department of Critical Care Medicine at all hospital levels are required to complete SRT.

Requirements for SRT in CCM

Resident physicians under a standardized CCM training must complete a 3-year phased training program. The program aims to cultivate professional integrity, clinical competence, patient management skills, communication and teamwork abilities, teaching capacity, and learning capabilities of clinical physicians, enabling them to independently establish fundamental diagnoses and provide treatment within the discipline. The detailed requirements can be found in the ``Content and Standards for Standardized Residency Training (2022 Edition) — Detailed Rules for Critical Care Medicine Training.''^[27]

Enhancing the development of SRT Bases for CCM

(1) Tertiary hospitals, particularly teaching hospitals affiliated with medical schools already accredited as SRT bases for internal medicine and surgery, are recommended to actively fulfill the requirements for and apply to become SRT bases for CCM. Specific requirements are outlined in the “Standard for Standardized Residency Training Bases (2022 Edition) – Detailed Rules for Critical Care Medicine Training Bases.” ^[28]

(2) Strengthening faculty training within the CCM training bases is recommended. Eligible supervising physicians and directors of specialized training bases are encouraged to participate in key faculty training programs for SRT in CCM. Additionally, residents should be encouraged to evaluate and provide feedback on their instructors to enhance the quality of clinical teaching.

(3) The teaching requirements and training capacity of specialized training bases must comply with the “Standard for Standardized Residency Training Bases (2022 Edition) – Detailed Rules for Critical Care Medicine Training Bases.”^[28]

Standardized subspecialty training in CCM

Intensivists, who have completed SRT, with further career aspirations should undergo standardized subspecialty training in CCM. The specific requirements can be found in the “Content and Standards for Standardized Subspecialty Training (2019 Edition).”^[29]

Chinese critical care certified course (5C) and core skill training programs

All practicing intensivists in hospitals at various levels should participate in the ``Chinese Critical Care Certified Course'' (abbreviated as 5C) and obtain the ``Certification of Completion.''

Additionally, intensivists should actively engage in core technical skill training programs organized by the CSCCM and obtain the corresponding certification upon passing the assessments.

Standardized training for CCM specialist nurses

Nurses in Department of Critical Care Medicine should undergo standardized training to become specialist nurses in CCM.

Specific requirements: The program aims to equip participants with the multifaceted competencies required for clinical practice, teaching, and research in CCM through comprehensive, systematic, and standardized training. Trainees should acquire solid clinical nursing practice skills, nursing quality management capabilities, education and consultation abilities, teamwork skills, and foundational teaching and research competencies. Thereby, the program cultivates highly qualified specialist nurses capable of working independently in clinical nursing within CCM.

Enhancing the development of training bases for CCM specialist nurses: (1) Tertiary hospitals, particularly teaching hospitals affiliated with medical schools, are recommended to actively work toward meeting the criteria for establishing standardized training bases for CCM specialist nursing and apply for accreditation. The comprehensive strength of the hospital, departmental scale, range of critical care nursing techniques performed, medical equipment, and clinical workload must comply with the “Accreditation Standards for Clinical Training Bases of Critical Care Specialist Nurses by the Chinese Nursing Association”;^[30] (2) Strengthening faculty training at CCM specialist nurse training bases is advised. Eligible nurses should be encouraged to participate in key faculty training programs for standardized specialist nurse training in CCM. Staffing allocations, qualifications of supervising instructors, and requirements for base directors must adhere to the “Accreditation Standards for Clinical Training Bases of Critical Care Specialist Nurses by the Chinese Nursing Association”.^[30]

Scientific Research in CCM

Construction of research platforms and scientific research systems for CCM

Department of CCM in affiliated hospitals of medical colleges, teaching hospitals, and provincial tertiary grade A hospitals should establish the following research platforms to meet basic and clinical research needs as possible^[31]: (1) Complete GCP certification and institutional filing for medical device clinical trials; (2) Disease-specific databases (such as sepsis, acute respiratory distress syndrome, or acute kidney injury), annotated disease-specific datasets, and biobanks in units with appropriate conditions; (3) Laboratories or research institutes for CCM at all levels in units with appropriate conditions; (4) An intelligent healthcare support system for critical care in units with appropriate conditions. Based on disease-specific databases, algorithms such as large language models, artificial neural networks, and machine learning models should be integrated to support early warning, subtype classification, and decision-making for various critical illnesses; (5) A deep international cooperation in Department of Critical Care Medicine in affiliated hospitals of medical colleges, teaching hospitals, and provincial tertiary grade A hospitals, such as joint graduate training and international multicenter clinical research.

Competency training and research directions in CCM

Intensivists are encouraged to be actively engaged in competency training for clinical and basic scientific research, including research topic selection, study design, drug clinical trials, literature retrieval and review, experimental skills, data analysis and visualization, and academic writing.

Intensivists are also encouraged to actively apply for research projects and talent programs, including various projects at the hospital, university, county (bureau), city (department), province (ministry), and national levels.

Recommended priority research directions for departments of CCM^[32] are (1) construction of big data centers and information management platforms for CCM; (2) acute respiratory distress syndrome (ARDS); (3) shock and hemodynamic monitoring and treatment; (4) infection and sepsis diagnosis and treatment; (5) acute kidney injury and blood purification; (6) analgesia and sedation; (7) gastrointestinal dysfunction and nutritional support strategies; (8) organ dysfunction and repair; (9) epidemiology of critical care-related diseases; and (10) cerebral function monitoring and brain protection.

Construction and requirements for scientific talent teams by hospital tier

Department of Critical Care Medicine should optimize the talent development environment to stimulate the innovative drive of scientific talents, improve talent training mechanisms to support high-quality development, promote talent introduction and aggregation to build talent teams and innovation hubs, deepen the ``diversified'' development reform of talents, and improve talent training, employment, evaluation, and incentive mechanisms. Furthermore, strengthening industry-university-research integration is essential to facilitate the efficient transformation of scientific research achievements by scientific talents, focus on talent incentive and security mechanisms to address concerns in talent development, and encourage applications for talent programs to build multi-level critical care scientific talent echelons.^[31]

Department of Critical Care Medicine in secondary hospitals with conditions should also strengthen the cultivation of critical care scientific talents by participating in scientific research training, establishing support relationships with research institutes, engaging in multicenter studies and research projects, and introducing talents.

GCP filing and qualification requirements for clinical research on drugs and medical devices

Clinical trials of drugs and medical devices in CCM should be conducted in clinical trial organizations meeting the corresponding conditions according to the Drug Administration Law of the People’s Republic of China, the Announcement of the National Medical Products Administration and the National Health Commission on Issuing the Provisions for the Management of Drug Clinical Trial Institutions (no. 101 [2019]), the Good Clinical Practice for Medical Device Trials, and the Measures for the Administration of Qualification Requirements and Record-filing for Medical Device Clinical Trial Institutions. Clinical Trial Organizations for drugs and medical devices must be filed and managed according to national requirements.^[33,34]

Response to Public Health Emergencies

Formulation of emergency response strategies

ICUs should respond promptly to public health emergencies by improving bed management and patient triage, implementing the principle of centralized treatment for critically ill and injured patients, and optimizing the allocation of medical resources. They should establish a hierarchical reporting and information-sharing mechanism, along with stratified treatment approaches and individualized “one patient, one plan” management. Multidisciplinary collaboration and teleconsultation systems are recommended to comprehensively improve both emergency response capacity and routine clinical care, including critical illness prevention and complication control.

Team building in emergency situations

During public health emergencies, ICU teams should mobilize expert resources, clearly define staff responsibilities at different levels within emergency plans, and form an MDT. A tiered personnel training mechanism is recommended, along with standardized handover systems and emergency response protocols. Additionally, strengthening infection prevention and control training, as well as personal protection skills, is advised. Furthermore, mechanisms for multidisciplinary collaboration, regional resource sharing, psychological support, and incentive systems should be implemented.

Integration of emergency plans with routine drills

Medical emergency response plans should be formulated based on risk assessments of potential public health emergencies, with regular drills to test their effectiveness. Plans should be revised promptly based on changing circumstances, implementation experiences, and lessons learned from drills. Training should focus on emergency organization and management, rapid response, technical protocols, material reserves, departmental coordination, and media communication. Practical exercises should emphasize multidisciplinary teamwork and the use of telemedicine platforms. A scientific evaluation system is required to continuously assess and improve the effectiveness of training.

Enhancement and Optimization of ICU Service Models

Early rehabilitation in the ICU

Once the critically ill patient’s condition is fully assessed and medical safety is ensured, initiating early bedside rehabilitation within 3–4 days of admission is recommended to improve outcomes. Several recent studies have shown that early bedside rehabilitation can improve the prognosis of critically ill patients in multiple dimensions, such as reducing the duration of mechanical ventilation and delirium and promoting physical function recovery.^[[35], [36], [37], [38]^] Furthermore, multiple international guidelines recommend early mobilization and rehabilitation in the ICU.^[39]

The Department of Critical Care Medicine should establish a rehabilitation team comprising intensivists, rehabilitation therapists (including physical, occupational, and speech therapists), nurses, and other relevant healthcare professionals. Multidisciplinary collaboration is essential in early rehabilitation and requires the CCM leadership. Moreover, patient and family cooperation also influences rehabilitation outcomes.^[40] Including family members should be considered according to the specific setup of each ICU.

Rehabilitation measures in ICUs include, but are not limited to, early mobilization, respiratory function training, and airway clearance techniques. Rehabilitation for critically ill respiratory patients aims at reducing physiological and psychological dysfunction, improving ventilation, preserving existing function, and promoting early recovery of the physical function.^[41] For ICU patients on mechanical ventilation, exercise includes positioning management with active and passive movements.^[42] Treating respiratory dysfunction is also important for early rehabilitation, aiming to improve ventilation and lung compliance, reduce the work of breathing, and clear airway secretions. Airway clearance techniques can be applied to mechanically ventilated patients for the prompt removal of secretions and maintenance of airway patency. Respiratory muscle strength training aims to enhance the strength and endurance of respiratory muscles, typically using incentive spirometers, pressure threshold devices, and resistance devices.^[[43], [44], [45]^]

Providing rehabilitation therapy that covers the entire disease course for critically ill patients and addressing the challenge of chronic critical illness by establishing and improving sub-ICU facilities are recommended. After surviving the acute critical phase, some patients enter a state of chronic critical illness, requiring a certain level of monitoring and rehabilitation therapy.^[46] For these patients, rehabilitation primarily includes functional recovery training, such as cognitive, swallowing, and motor rehabilitation, to help them regain daily living abilities as soon as possible. Patients receiving physical rehabilitation in well-managed step-down units after the acute phase demonstrate improvements in physical and cognitive function with favorable safety profiles.^[[47], [48], [49]^] Therefore, establishing step-down units under the management of the ICU and providing targeted functional training are recommended to accelerate patient recovery.

MDT on the critical care platform

The Department of Critical Care Medicine should organize an MDT for collaborative diagnosis and treatment of complex and critical cases. Diagnosis and treatment in the MDT is a patient-centered, disease-oriented approach when experts from multiple disciplines collaboratively develop personalized and comprehensive diagnosis and treatment plans through joint discussion.^[50,51] MDT provides a platform for academic exchange and clinical collaboration across different disciplines, enhances the comprehensive capabilities of the medical team, optimizes diagnostic and therapeutic methods, and strengthens scientific research and innovation, playing a positive role in hospital development.

Telemedicine

Regional tertiary critical care centers should actively collaborate with primary ICUs to establish tele-critical care systems. Telemedicine in CCM, also known as ICU telemedicine programs (tele-ICU), is a care delivery model providing continuous critical care interventions through telemedicine. It aims to expand or supplement ICU capacity,^[52] thereby addressing ICU resource shortages and variability in treatment quality and ultimately improving clinical outcomes of ICU patients. Tele-ICU implementation is associated with shorter hospitalization and lower mortality. Furthermore, tele-ICU may reduce ICU operational costs through optimized resource allocation.^[53]

The construction of CCM and critical care capacity in China has advanced rapidly in recent years. However, significant challenges remain, including uneven regional development and disparities in treatment quality. The provincial-municipal-county three-tier tele-ICU system, which was established under national policies such as the development of medical consortia and the Thousand Counties Project, can standardize diagnosis and treatment practices in primary hospital ICUs, strengthen quality control management, and promote homogeneous and standardized medical care in CCM, ultimately reducing mortality. During public health emergencies or scenarios when many ICU patients or injured people need urgent rescue, the tele-ICU system optimizes the utilization of critical care expert resources, overcoming limitations such as physical distance, geographical barriers, and operational constraints. This ensures that all patients have access to the most optimal diagnostic and therapeutic strategies.

The establishment of a three-tier tele-ICU system requires the prior implementation of bilateral ICU platforms and foundational infrastructure development. The operationalization of the tele-ICU system necessitates the refinement of institutional protocols, division of responsibilities, workflow procedures, and performance incentives and accountability mechanisms. Team members operating within the tele-ICU framework must complete cross-regional practice registration filing in advance to secure legal credentials.

Hierarchical diagnosis and treatment system and two-way referral mechanism

Advancing the development of hierarchical diagnosis and treatment systems and two-way referral mechanisms in CCM through the framework of medical consortia is recommended. The two-way referral mechanism serves as a critical measure for effectively allocating medical service resources between regional higher- and lower-tier healthcare institutions and establishing a rational hierarchical care system.^[54] Imbalances in critical care capabilities and resource distribution across regions have become increasingly evident with the recent rapid advancements. Thus, ICUs in university-affiliated hospitals, teaching hospitals, and provincial tertiary hospitals must accelerate ICU bed turnover by transferring stabilized patients to primary ICUs for continued care to address the growing demand for treating critically ill patients. Conversely, primary ICUs, which are constrained by limited resources and capabilities, need to transfer patients that exceed their treatment capacity to university-affiliated hospitals, teaching hospitals, or provincial tertiary hospitals. This process fulfills the essential requirements of hierarchical diagnosis and treatment of critically ill patients, together with the two-way referral.

The development of medical consortia serves as a key platform and service carrier for advancing the hierarchical diagnosis and treatment system at the current stage.^[55] The hierarchical diagnosis and treatment system, as well as the two-way referral mechanism, in CCM should actively seek government support and top-level hospital management planning. Efforts should be focused on strengthening talent cultivation and implementing grassroots ward rounds and training programs to build homogeneous disciplines within medical consortia.^[56] Furthermore, establishing bidirectional referral and resource-sharing platforms, clarifying incentive and oversight mechanisms, and refining the referral system are mandatory. Operational charters, capability demarcation, and bidirectional referral criteria must be defined in the development of CCM consortia to ensure that healthcare institutions at all levels leverage their respective strengths, coordinate across tiers, and optimize resource utilization.

In summary, this guideline provides a comprehensive roadmap for the construction and high-quality development of CCM in China. It focuses on nine key domains related to foundational development (standardization of ICU ward construction, staffing and technical requirements, and equipment allocation), quality improvement measures (optimization of medical quality management and control systems, promotion of multidisciplinary collaboration, and the development of telemedicine and tiered diagnosis and treatment systems), capacity building (strengthening standardized training and continuing education, and enhancing emergency response capacity for major public health events), and research and future development priorities (advancing scientific research capacity in critical care, promoting technological innovation, cultivating high-level leading talents, and expanding international influence).

This guideline aims to enhance the overall capacity for comprehensive critical care, improve the quality of services and the level of CCM nationwide, and strengthen the establishment of an efficient, collaborative, and sustainable critical care system. Furthermore, it seeks to drive scientific innovation and breakthroughs in international competitiveness, thereby continuously advancing the progress and development of CCM in China.

Committee Member for the Development of this Guideline (in alphabetical order by last name)

Advisory Committee

Youzhong An (Department of Critical Care Medicine, Peking University People’s Hospital); Dechang Chen (Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine); Bin Du (Department of Critical Care Medicine, Peking Union Medical College Hospital); Xiangdong Guan (Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University); Yuan Gao (Department of Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine); Xiaobo Huang (Department of Critical Care Medicine, Sichuan Provincial People’s Hospital); Yingzi Huang (Department of Critical Care Medicine, Zhongda Hospital, Southeast University); Yan Kang (Department of Critical Care Medicine, West China Hospital, Sichuan University); Yimin Li (Department of Critical Care Medicine, The First Affiliated Hospital, Guangzhou Medical University); Jianguo Li (Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University); Weiqin Li (Department of Critical Care Medicine, Eastern Theater Command General Hospital of PLA); Wenxiong Li (Surgical ICU, Beijing Chaoyang Hospital, Capital Medical University); Hong Liu (Department of Critical Care Medicine, The First Hospital of Shanxi Medical University); Jian Liu (Department of Critical Care Medicine, Gansu Provincial Central Hospital); Penglin Ma (Department of Critical Care Medicine, Guizhou International General Hospital); Xiaochun Ma (Department of Critical Care Medicine, The First Hospital, China Medical University); Zhiyong Peng (Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University); Chuanyun Qian (Department of Emergency Medicine, The First Affiliated Hospital of Kunming Medical University); Haibo Qiu (Department of Critical Care Medicine, Zhongda Hospital, Southeast University); Bingyu Qin (Department of Emergency and Critical Care Medicine, Henan Provincial People’s Hospital); Songjing Shi (Second Department of Critical Care Medicine, Fujian Provincial Hospital); Tongwen Sun (Department of Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University); Chunting Wang (Department of Critical Care Medicine, Shandong Provincial Hospital); Hongliang Wang (Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University); Jianfeng Wu (Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University); Bin Xiong (Department of Critical Care Medicine, People’s Hospital of Guangxi Zhuang Autonomous Region); Lei Xu (Department of Critical Care Medicine, Tianjin Third Central Hospital); Yuan Xu (Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital); Jing Yan (Department of Critical Care Medicine, Zhejiang Hospital); Yi Yang (Department of Critical Care Medicine, Zhongda Hospital, Southeast University); Kaijiang Yu (Department of Critical Care Medicine, The First Affiliated Hospital, Harbin Medical University); Xiangyou Yu (Department of Critical Care Medicine, The First Affiliated Hospital, Xinjiang Medical University); Mingyan Zhao (Department of Critical Care Medicine, The First Affiliated Hospital, Harbin Medical University); Lina Zhang (Department of Critical Care Medicine, Xiangya Hospital, Central South University); Xijing Zhang (Department of Critical Care Medicine, The First Affiliated Hospital, Air Force Medical University); Ruiqiang Zheng (Department of Critical Care Medicine, Northern Jiangsu People’s Hospital); Fachun Zhou (Department of Critical Care Medicine, The First Affiliated Hospital, Chongqing Medical University); Feihu Zhou (Department of Critical Care Medicine, First Medical Center, Chinese PLA General Hospital); Jianxin Zhou (Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University)

Chair

Dechang Chen (Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine)

Secretary

Jianfeng Wu (Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University);

Hui Xie (Department of Emergency and Critical Care Medicine, Shanghai General Hospital);

Xijing Zhang (Department of Critical Care Medicine, The First Affiliated Hospital, Air Force Medical University)

Writing group member

Shuhan Cai (Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University); Dechang Chen (Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine); Wei Du (Department of Critical Care Medicine, Peking Union Medical College Hospital); Bo Hu (Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University); Lu Ke (Department of Critical Care Medicine, Eastern Theater Command General Hospital of PLA); Airan Liu (Department of Critical Care Medicine, Zhongda Hospital, Southeast University); Jiao Liu (Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine); Yun Long (Department of Critical Care Medicine, Peking Union Medical College Hospital); Qianyi Peng (Department of Critical Care Medicine, Xiangya Hospital, Central South University); You Shang (Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology); Yanfei Shen (Department of Critical Care Medicine, Zhejiang Hospital); Xuan Song (Department of Critical Care Medicine, Public Health Clinical Center, Shandong University); Changsong Wang (Department of Critical Care Medicine, The First Affiliated Hospital, Harbin Medical University); Jianfeng Wu (Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University); Hui Xie (Department of Emergency and Critical Care Medicine, Shanghai General Hospital); Jianfeng Xie (Department of Critical Care Medicine, Zhongda Hospital, Southeast University); Yonghao Xu (Department of Critical Care Medicine, The First Affiliated Hospital, Guangzhou Medical University); Haiyan Yin (Department of Critical Care Medicine, The First Affiliated Hospital, Jinan University); Sheng Zhang (Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine); Xijing Zhang (Department of Critical Care Medicine, The First Affiliated Hospital, Air Force Medical University); Huiying Zhao (Department of Critical Care Medicine, Peking University People’s Hospital); Xiang Zhou (Department of Critical Care Medicine, Peking Union Medical College Hospital);

CRediT authorship contribution statement

Guideline Working Group of the Chinese Society of Critical Care Medicine: . Yan Kang: Project administration, Supervision, Writing – review & editing. Xiangdong Guan: Project administration, Supervision, Writing – review & editing. Dechang Chen: Project administration, Supervision, Writing – review & editing.

Managing Editor: Jingling Bao/Zhiyu Wang