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JCM
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Acute Hypoxemic Respiratory Failure: Progress, Challenges and Future
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Acute Hypoxemic Respiratory Failure: Progress, Challenges and Future

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: 20 March 2026 | Viewed by 1761

Special Issue Editors

Prof. Dr. Davide Alberto Chiumello

E-Mail Website
Guest Editor
Department of Anesthesia and Intensive Care, ASST Santi Paolo Carlo Milano, Milan, Italy
Interests: acute respiratory distress syndrome; acute respiratory failure; lung imaging; extracorporeal membrane oxygenation; esophageal pressure; prone position; mechanical ventilation
Dr. Jesús Villar

E-Mail Website
Guest Editor
1. CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029 Madrid, Spain
2. Research Unit, Hospital Universitario Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain
Interests: acute respiratory failure; acute respiratory distress syndrome; mechanical ventilation; sepsis; epidemiological studies and clinical trials
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are planning a Special Issue on acute hypoxemic respiratory failure (AHRF) in JCM. AHRF is a heterogeneous syndrome encompassing conditions like ARDS, acute lung injury, and hypoxemia from sepsis, trauma, or viral infections (e.g., COVID-19). We seek submissions that bridge evidence and bedside care, exploring critical questions.

All of the most important topics spanning protective, infection, imaging, hemodynamic, and artificial intelligence fields will be considered. This Special  Issue aims to bridge translational gaps and foster multidisciplinary solutions to address challenges in AHRF.

We are looking forward to your submissions.

Prof. Dr. Davide Alberto Chiumello
Dr. Jesús Villar
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ARDS
  • artificial intelligence
  • mechanical ventilation
  • non-invasive ventilation
  • lung imaging

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Published Papers (2 papers)

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13 pages, 375 KB  
Article
Predicting Outcome and Duration of Mechanical Ventilation in Acute Hypoxemic Respiratory Failure: The PREMIER Study
by Jesús Villar, Jesús M. González-Martín, Cristina Fernández, Juan A. Soler, Marta Rey-Abalo, Juan M. Mora-Ordóñez, Ramón Ortiz-Díaz-Miguel, Lorena Fernández, Isabel Murcia, Denis Robaglia, José M. Añón, Carlos Ferrando, Dácil Parrilla, Ana M. Dominguez-Berrot, Pilar Cobeta, Domingo Martínez, Ana Amaro-Harpigny, David Andaluz-Ojeda, M. Mar Fernández, Estrella Gómez-Bentolila, Ewout W. Steyerberg, Luigi Camporota and Tamas Szakmanyadd Show full author list remove Hide full author list
J. Clin. Med. 2025, 14(22), 7903; https://doi.org/10.3390/jcm14227903 - 7 Nov 2025
Viewed by 659
Abstract
Objectives: The ability of clinicians to predict prolonged mechanical ventilation (MV) in patients with acute hypoxemic respiratory failure (AHRF) is inaccurate, mainly because of the competitive risk of mortality. We aimed to assess the performance of machine learning (ML) models for the early [...] Read more.
Objectives: The ability of clinicians to predict prolonged mechanical ventilation (MV) in patients with acute hypoxemic respiratory failure (AHRF) is inaccurate, mainly because of the competitive risk of mortality. We aimed to assess the performance of machine learning (ML) models for the early prediction of prolonged MV in a large cohort of patients with AHRF. Methods: We analyzed 996 ventilated AHRF patients with complete data at 48 h after diagnosis of AHRF from 1241 patients enrolled in a prospective, national epidemiological study, after excluding 245 patients ventilated for <2 days. To account for competing mortality, we used multinomial regression analysis (MNR) to model prolonged MV in three categories: (i) ICU survivors (regardless of MV duration), (ii) non-survivors ventilated for 2–7 days, (iii) non-survivors ventilated for >7 days. We performed 4 × 10-fold cross-validation to validate the performance of potent ML techniques [Multilayer Perceptron (MLP), Support Vector Machine (SVM), Random Forest (RF)] for predicting patient assignment. Results: All-cause ICU mortality was 32.8% (327/996). We identified 12 key predictors at 48 h of AHRF diagnosis: age, specific comorbidities, sequential organ failure assessment score, tidal volume, PEEP, plateau pressure, PaO2, pH, and number of organ failures. MLP showed the best predictive performance [AUC 0.86 (95%CI: 0.80–0.92) and 0.87 (0.80–0.93)], followed by MNR [AUC 0.83 (0.76–0.90) and 0.84 (0.77–0.91)], in distinguishing ICU survivors, with non-survivors ventilated 2–7 days and >7 days, respectively. Conclusions: Accounting for ICU mortality, MLP and MNR offered accurate patient-level predictions. Further work should integrate clinical and organizational factors to improve timely management and optimize outcomes. This study was initially registered on 3 February 2025 at ClinicalTrials.gov (NCT06815523). Full article
(This article belongs to the Special Issue Acute Hypoxemic Respiratory Failure: Progress, Challenges and Future)
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21 pages, 1464 KB  
Systematic Review
Systematic Review of Extracorporeal Membrane Oxygenation in Adult Sickle Cell Disease
by Safa Khalil Ebrahim Al Taitoon and Kannan Sridharan
J. Clin. Med. 2025, 14(19), 6725; https://doi.org/10.3390/jcm14196725 - 24 Sep 2025
Viewed by 932
Abstract
Background: Sickle cell disease (SCD) is a hereditary hemoglobinopathy associated with life-threatening complications such as acute chest syndrome (ACS), which may necessitate extracorporeal membrane oxygenation (ECMO) in refractory cases. Despite growing use, ECMO in SCD remains challenging due to risks of hemolysis, thrombosis, [...] Read more.
Background: Sickle cell disease (SCD) is a hereditary hemoglobinopathy associated with life-threatening complications such as acute chest syndrome (ACS), which may necessitate extracorporeal membrane oxygenation (ECMO) in refractory cases. Despite growing use, ECMO in SCD remains challenging due to risks of hemolysis, thrombosis, and anticoagulation complications. This systematic review consolidates existing evidence on ECMO outcomes in SCD, focusing on indications, complications, and survival. Methods: A systematic search of MEDLINE, Cochrane CENTRAL, and Google Scholar was conducted up to January 2025, identifying case reports/series on ECMO use in SCD. Studies reporting venovenous (VV) or venoarterial (VA) ECMO for acute cardiopulmonary failure were included. Data on demographics, laboratory findings, management, and outcomes were extracted. Quality assessment was performed using the Joanna Briggs Institute checklist. Results: Sixteen case reports (23 patients) were included. Most patients were female (65.2%), with ACS (47.8%) and pulmonary embolism (13.0%) as common ECMO indications. VV-ECMO (69.6% of cases) was primarily used for respiratory failure, with a 69% survival rate, while VA-ECMO (30.4%) had a 29% survival rate, often due to cardiogenic shock or cardiac arrest. Complications included hemorrhage (26.1%), neurological injury (21.7%), and thrombosis (13.0%). Exchange transfusion was frequently employed (43.5%), with post-ECMO echocardiography showing improved right ventricular function in survivors. Conclusions: VV-ECMO demonstrates favorable outcomes in SCD-related respiratory failure, whereas VA-ECMO carries higher mortality risks. Careful patient selection, anticoagulation management, and multidisciplinary coordination are essential. Larger prospective studies are needed to refine ECMO utilization in this high-risk population. Full article
(This article belongs to the Special Issue Acute Hypoxemic Respiratory Failure: Progress, Challenges and Future)
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