This narrative review synthesizes our current understanding of sepsis and septic shock burden in intensive care units (ICUs) worldwide. Based on a comprehensive but non-systematic literature search from 2000 to 2025, this review synthesizes our current understanding across eight key domains: epidemiology, pathophysiology, diagnostics, management strategies, long-term outcomes, disparities, and future directions. The global burden of sepsis, especially in the developed and developing world, is great: over 48 million cases per year, with mortality rates at the ICU level in the range of 30 to 50%, depending on geography and resources. The pathophysiological progression from an initial hyper-inflammatory state to immune paralysis underlies organ failure and complicates therapeutic targeting. Diagnostic approaches, including clinical scoring systems, biomarkers (e.g., procalcitonin, MR-proADM), and emerging AI tools, offer improved early detection but face challenges in reliability and accessibility. Management in the ICU remains anchored in timely antimicrobial administration, hemodynamic stabilization with balanced fluids and vasopressors, source control, and organ support, including lung-protective ventilation and kidney replacement therapy. Novel adjuncts, such as immunomodulators and extracorporeal therapies, show promise but demand further validation. Importantly, survivors face significant long-term sequelae—post-intensive care syndrome (PICS)—encompassing physical, cognitive, and psychological impairments, which require structured rehabilitation and follow-up. The future of sepsis care lies in integrating precision medicine—through molecular diagnostics, individualized immunotherapy, and AI-supported monitoring—with scalable, equitable implementation strategies that bridge the gap between high- and low-income settings. Addressing disparities and expanding rehabilitation services are essential to improving survival and long-term quality of life in sepsis survivors.

Critically ill patients receiving continuous renal replacement therapy (CRRT) face distinct nutritional challenges requiring specialized parenteral nutrition (PN) strategies. This review synthesizes current evidence with clinical expertise to provide a comprehensive nutritional framework for this population. Key findings reveal that CRRT significantly impacts nutrient homeostasis through daily losses of amino acids (14–22 g), water-soluble vitamins, and trace elements via the extracorporeal circuit. Results from observational studies demonstrate that higher protein targets (1.8–2.5 g/kg/day) are necessary to achieve positive nitrogen balance, while energy prescriptions must subtract “hidden” calories from citrate anticoagulation (3–4 kcal/mmol) and propofol (1.1 kcal/mL). Clinical outcome data, though primarily observational, indicate that achieving nutritional adequacy correlates with reduced ICU stays (average reduction 2.1–3.4 days), shorter mechanical ventilation duration, and improved functional recovery. Evidence supports that early PN prescription when indicated, coupled with systematic consideration of therapy modality, extracorporeal losses, oral intake capacity, and mobilization status, optimizes nutritional support. We conclude that successful implementation requires: (1) dynamic adjustment based on CRRT parameters, (2) integration with enteral nutrition when feasible, (3) regular metabolic monitoring, (4) multidisciplinary collaboration, and (5) structured protocols. Future research using point-of-care analysis and AI-driven support systems is needed to establish evidence-based guidelines in this specialized population.

Artificial intelligence (AI) is rapidly transforming anesthesiology practice across perioperative settings. This review explores the evolution and implementation of hybrid decision-making models that integrate AI capabilities with human clinical expertise. From historical foundations to current applications, we examine how machine learning algorithms, deep learning networks, and big data analytics are enhancing anesthetic care. Key applications include perioperative risk prediction, AI-assisted patient education, automated analysis of clinical records, airway management support, predictive hemodynamic monitoring, closed-loop anesthetic delivery systems, and pain management optimization. In procedural contexts, AI demonstrates promising utility in regional anesthesia through anatomical structure identification and needle navigation, monitoring anesthetic depth via EEG analysis, and improving quality control in endoscopic sedation. Educational applications include intelligent simulators for procedural training and academic productivity tools. Despite significant advances, implementation challenges persist, including algorithmic bias, data security concerns, clinical validation requirements, and ethical considerations regarding AI-generated content. The optimal integration model emphasizes a complementary approach where AI augments rather than replaces clinical judgment—combining computational efficiency with the irreplaceable contextual understanding and ethical reasoning of the anesthesiologist. This hybrid paradigm reinforces the anesthesiologist’s leadership role in perioperative care while enhancing safety, precision, and efficiency through technological innovation. As AI integration advances, continued emphasis on algorithmic transparency, rigorous clinical validation, and human oversight remains essential to ensure that these technologies enhance rather than compromise patient-centered anesthetic care.