Persistent critical illness in acute hypoxic respiratory failure: A retrospective cohort study
- 1Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- 2Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, United States of America
- 3Center for Care Delivery and Outcomes Research (CCDOR) VA Minneapolis Healthcare System, Minneapolis, Minnesota, United States of America
Abstract
Introduction: Persistent critical illness (PerCI) describes patients with prolonged intensive care unit (ICU) dependence after their acute phase of illness and affects 5–20% of the general ICU population. PerCI has been studied in the general ICU cohort, but prevalence and outcomes remain unclear among mechanically ventilated patients with acute hypoxic respiratory failure (AHRF), a high-risk cohort that is more prone to ICU-associated complications. The objective of this study is to quantify PerCI prevalence, identify risk factors for PerCI development, and describe one-year mortality in this population. Methods: We conducted a retrospective study of patients with AHRF (PaO2/FiO2 ratio < 300) requiring mechanical ventilation within 72 hours of ICU admission across a 12-hospital health system (2011–2022). PerCI was defined as ICU length of stay ≥ 10 days. The primary outcome was one-year mortality, modeled using a Cox proportional hazards model with PerCI as a time-varying exposure. To identify risk factors for PerCI while accounting for competing early mortality, we used a dual-model approach: logistic regression comparing PerCI to early death (≤ 10-day mortality) and PerCI to early ICU discharge, with factors associated with both models considered robust predictors. Results: Among 10,626 eligible patients, 3,107 (29.2%) met criteria for PerCI. One-year survival was 64.2% in the PerCI group compared to 73.8% in the non-PerCI group. After PerCI onset, mortality risk increased threefold (hazard ratio 3.01; 95% CI 2.72–3.33). Factors consistently associated with PerCI across both models included ARDS, pneumonia, aspiration pneumonitis, heart failure, septic shock, weight loss, surgical admission, and postprocedural respiratory and circulatory failure. Conclusion: Nearly one in three mechanically ventilated AHRF patients developed PerCI, far exceeding rates in the general ICU populations and was associated with worse one-year survival. Identifiable clinical risk factors may support earlier goals-of-care conversations and post-ICU care planning in this high-risk population.
Related
- Components of institution-free days as a composite outcome after critical illness: A retrospective cohort study
- Medical nutrition therapy during the first 5 days of critical illness: a retrospective cohort study
- Clinical Relevance of Multiplex PCR for Respiratory Pathogens in Hospitalized Adults with Influenza-Like Illness
- Developing a multi-component immune model for evaluating the risk of respiratory illness in athletes
- Hypoxic burden, systemic inflammation and respiratory muscle dysfunction in obstructive sleep apnoea: a multicentre cross-sectional study
BibTeX
@article{kalinoski2026persistent,
title = {{Persistent critical illness in acute hypoxic respiratory failure: A retrospective cohort study}},
author = {Michael Kalinoski and Leah Bolden and Qi Wang and R. Adams Dudley and Nathan Mesfin and Nicholas E. Ingraham},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358431},
url = {https://doi.org/10.1371/journal.pone.0358431},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Persistent critical illness in acute hypoxic respiratory failure: A retrospective cohort study
AU - Michael Kalinoski
AU - Leah Bolden
AU - Qi Wang
AU - R. Adams Dudley
AU - Nathan Mesfin
AU - Nicholas E. Ingraham
PY - 2026
DA - 2026/09/16
JO - PLOS One
DO - 10.1371/journal.pone.0358431
UR - https://doi.org/10.1371/journal.pone.0358431
AB - Introduction: Persistent critical illness (PerCI) describes patients with prolonged intensive care unit (ICU) dependence after their acute phase of illness and affects 5–20% of the general ICU population. PerCI has been studied in the general ICU cohort, but prevalence and outcomes remain unclear among mechanically ventilated patients with acute hypoxic respiratory failure (AHRF), a high-risk cohort that is more prone to ICU-associated complications. The objective of this study is to quantify PerCI prevalence, identify risk factors for PerCI development, and describe one-year mortality in this population. Methods: We conducted a retrospective study of patients with AHRF (PaO2/FiO2 ratio < 300) requiring mechanical ventilation within 72 hours of ICU admission across a 12-hospital health system (2011–2022). PerCI was defined as ICU length of stay ≥ 10 days. The primary outcome was one-year mortality, modeled using a Cox proportional hazards model with PerCI as a time-varying exposure. To identify risk factors for PerCI while accounting for competing early mortality, we used a dual-model approach: logistic regression comparing PerCI to early death (≤ 10-day mortality) and PerCI to early ICU discharge, with factors associated with both models considered robust predictors. Results: Among 10,626 eligible patients, 3,107 (29.2%) met criteria for PerCI. One-year survival was 64.2% in the PerCI group compared to 73.8% in the non-PerCI group. After PerCI onset, mortality risk increased threefold (hazard ratio 3.01; 95% CI 2.72–3.33). Factors consistently associated with PerCI across both models included ARDS, pneumonia, aspiration pneumonitis, heart failure, septic shock, weight loss, surgical admission, and postprocedural respiratory and circulatory failure. Conclusion: Nearly one in three mechanically ventilated AHRF patients developed PerCI, far exceeding rates in the general ICU populations and was associated with worse one-year survival. Identifiable clinical risk factors may support earlier goals-of-care conversations and post-ICU care planning in this high-risk population.
SN - 1932-6203
ER -