Search Results (693)

Intensive Care Units (ICUs) face unprecedented challenges in resource allocation, particularly during health crises in which algorithmic systems may be exposed to adversarial manipulation. A transformer-based expert system, ICU-Transformer, is presented to optimize resource allocation across 200 ICUs in Physionet while maintaining robustness against data poisoning attacks. The framework incorporates a Robust Multi-Head Attention mechanism that achieves an AUC-ROC of 0.891 in mortality prediction under 20% data contamination, outperforming conventional baselines. The system is trained and evaluated using data from the MIMIC-IV and eICU Collaborative Research Database and is deployed to manage more than 50,000 ICU admissions annually. A Resource Optimization Engine (ROE) is introduced to dynamically allocate ventilators, Extracorporeal Membrane Oxygenation (ECMO) machines, and specialized clinical staff based on predicted deterioration risk, resulting in an 18% reduction in preventable deaths. A Surge Capacity Planner (SCP) is further employed to simulate disaster scenarios and optimize cross-hospital resource distribution. Deployment across the Physionet ICU Network demonstrates improvements, including a 2.1-day reduction in average ICU bed turnover time, a 31% decrease in unnecessary admissions, and an estimated USD 142 million in annual operational savings. During the observation period, 234 algorithmic manipulation attempts were detected, with targeted disparities identified and mitigated through enhanced auditing protocols. Full article

Acinetobacter baumannii is a leading intensive care unit (ICU) pathogen associated with high rates of carbapenem resistance and poor clinical outcomes. This narrative review synthesizes recent clinical, microbiological, and pharmacokinetic/pharmacodynamic (PK/PD) evidence regarding resistance mechanisms and therapeutic strategies. A literature review was performed in PubMed, Scopus, and Web of Science (January 2015–August 2025), focusing on multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains, ICU-acquired infections, and pivotal trials involving cefiderocol and sulbactam–durlobactam. Resistance is driven by OXA-type carbapenemases (notably OXA-23/24/58), efflux systems (AdeABC/IJK/FGH), porin alterations (CarO, Omp33–36), and lipopolysaccharide (LPS) modifications conferring colistin resistance. Management options include polymyxins, optimized tigecycline dosing, β-lactam/β-lactamase inhibitors, and newer agents such as cefiderocol and sulbactam–durlobactam, though mortality and safety outcomes vary across trials. A comparative table is included, summarizing antimicrobial mechanism coverage, PK/PD parameters, and adverse effects to support regimen selection in ventilator-associated pneumonia (VAP) and bacteremia. Optimized, multimodal approaches integrating timely diagnostics, targeted combination therapies, infection prevention, and antimicrobial stewardship are essential to improve outcomes and limit the spread of MDR and XDR A. baumannii. Full article

Background: Respiratory syncytial virus (RSV) pneumonia is an underrecognized cause of critical illness in adults. However, the influence of biological sex on intensive care unit (ICU) outcomes in this population remains unclear. Due to limited case numbers and incomplete covariate data, this study was designed as exploratory and hypothesis-generating. Methods: We conducted a retrospective exploratory cohort study using the MIMIC-IV database and identified 105 adult ICU patients with laboratory-confirmed RSV pneumonia. Clinical variables included sex, age, ICU length of stay, use of mechanical ventilation, and weaning status. Exploratory multivariable logistic regression was performed to assess associations with in-hospital mortality and weaning success, acknowledging substantial missingness of comorbidity data, severity scores, and treatment variables. This limited adjustment for confounding and statistical power. Results: Overall, in-hospital mortality was 33.3%. Mortality was significantly higher among women than men (51.6% vs. 7.0%; p < 0.001), although the absolute number of deaths in men was very small. In adjusted models, female sex (OR 14.6, 95% CI 1.58–135.3, p = 0.018), reflecting model instability due to sparse events, as well as longer ICU stay (OR 1.22 per day, p = 0.001) were independently associated with higher mortality. Female sex was also associated with lower odds of successful weaning (OR 0.07, 95% CI 0.01–0.63, p = 0.018). These effect estimates must be interpreted cautiously due to the very small number of deaths in men and the resulting wide confidence intervals. Age and ventilation duration were not significant predictors. Conclusions: In this preliminary ICU cohort, female sex and prolonged ICU stay were linked to higher mortality and lower weaning success in adults with RSV pneumonia. However, given the very small number of events—particularly among male patients—together with the modest sample size, limited covariate availability, and unstable effect estimates, the findings should be viewed as exploratory rather than confirmatory. Larger, well-powered, prospective multicenter studies are needed to validate and further characterize potential sex-related differences in outcomes of RSV-associated critical illness. Full article

Chronic obstructive pulmonary disease (COPD) is a recognized risk factor for poor outcomes in SARS-CoV-2 infection, yet its specific impact on critically ill patients remains unclear. We aimed to compare the clinical and laboratory profiles of ICU SARS-CoV-2 pneumonia patients with or without pre-existing COPD and identify factors associated with mortality among those with COPD. In this retrospective study, adult intensive care unit (ICU) admissions for SARS-CoV-2 pneumonia (n = 1536) were divided into a COPD group (n = 253) and a non-pulmonary-disease (NPD) group (n = 1283). Demographics and clinical characteristics, severity of disease, length of stay, laboratory values, and survival outcomes were compared. COPD patients were older, had higher Acute Physiology and Chronic Health Evaluation score, and had a greater prevalence of comorbidities (p < 0.05). They required invasive mechanical ventilation (IMV) more frequently, had experienced higher mortality, and had shorter hospital stays (p < 0.05). Ferritin levels were lower in COPD patients (p < 0.001). Multivariate regression analysis also identified that length of hospital stay, IMV, elevated procalcitonin, and neutrophil-to-lymphocyte ratio (NLR) were associated with COPD patients’ mortality (p < 0.05). COPD is associated with an increased disease burden and mortality rate in critically ill SARS-CoV-2 patients. High NLR levels and IMV are significantly associated with mortality in these patients. Full article

Background: This study aimed to assess whether methylprednisolone treatment, while effective in reducing COVID-19 mortality, increases the risk of intensive-care-unit-acquired respiratory tract infections (RTI-ICU) in critically ill patients. Methods: This was a multicenter prospective cohort study conducted in ten countries across Latin America and Europe. It included patients over 18 years of age with confirmed SARS-CoV-2 infection who required ICU admission. A multivariable logistic regression analysis and propensity score matching (PSM) were performed to determine the association between methylprednisolone treatment and RTI-ICU. Results: A total of 3239 patients were included, of whom 1527 patients (47.1%) were treated with methylprednisolone. Methylprednisolone treatment was associated with a higher risk of developing RTI-ICU (OR = 1.59; 95% CI: 1.33–1.91). Patients with RTI-ICU had a significantly higher average number of days on invasive mechanical ventilation (IMV) (24.6, SD: 15.9 vs. 9.5, SD: 11.7; p < 0.001), longer hospital stays (40 days, SD: 24.9 vs. 24.4 days, SD: 18.7; p < 0.001), and higher ICU mortality (39.2%, 259/660 vs. 29.2%, 754/2579; p < 0.001). Conclusions: Methylprednisolone treatment is associated with an increased risk of RTI-ICU in critically ill patients with COVID-19. RTI-ICU was linked to higher mortality, a greater need for invasive mechanical ventilation, prolonged ICU stay, elevated leukocyte and C-reactive protein levels, and a higher comorbidity burden. However, methylprednisolone may not be the sole factor explaining these differences, as residual confounding related to baseline disease severity and comorbidities could have influenced the outcomes. Full article

Background: High-chloride solutions such as 0.9% saline are widely used for medication dilution in intensive care units (ICUs) and are an underrecognized source of hyperchloremia and acid–base disturbances. Excess chloride reduces the strong ion difference (SID), contributing to hyperchloremic metabolic acidosis and worse clinical outcomes. This study evaluated the impact of replacing isotonic saline with 5% dextrose as a diluent on ICU outcomes in mechanically ventilated patients. Methods: In this retrospective cohort study, 4347 adult ICU patients requiring ≥12 h of mechanical ventilation were analyzed across two periods with different diluent strategies (2015–2018: saline-based; 2019–2025: chloride-sparing, dextrose-based). Demographics, comorbidities, illness severity (APACHE II, SOFA), fluid exposure, SID, and laboratory values over the first 48 h were compared. Predictors of mortality were identified using multivariate logistic regression. Results: Mortality decreased from 44.6% to 39.2% after adoption of chloride-sparing diluents (absolute reduction 5.4%, p = 0.003), despite similar renal function across periods. The later cohort demonstrated significantly higher SID (median 39 vs. 38 mmol/L; p < 0.001), lower chloride levels, and more favorable acid–base profiles. In 2015–2018, chloride showed a strong association with mortality (~12–13% increased odds per mmol/L), while in 2019–2025 the association persisted but was attenuated (~2% per mmol/L). SID emerged as a significant marker of improved acid–base balance after the diluent transition. pH remained the most powerful predictor of mortality in both periods. Mean glucose levels increased by ~30–40 mg/dL after switching to dextrose diluents, although insulin requirements did not change. Conclusions: Transitioning from chloride-rich to chloride-sparing diluents was associated with reduced ICU mortality and improved acid–base balance, without changes in renal function. However, modestly increased glucose levels highlight the need for strict glycemic monitoring. These findings support chloride-sparing strategies with robust glycemic monitoring in critical care. Full article

Background/Objectives: Postoperative pneumonia (PP) is a significant complication following thoracic surgery, increasing morbidity, mortality, and hospital length of stay. Identifying risk factors is crucial for optimizing perioperative management. This study analyses predictors for PP in patients undergoing anatomical lung resections in a single center setting. Methods: A prospective cohort study was conducted using data from the German Thoracic Registry (GTR). Patients who underwent anatomical lung resection were included in the study, while non-anatomical resections and cases with missing data were excluded. The primary outcome measure was the incidence of PP, which was analyzed using chi-square tests and Fisher’s exact test. Results: PP was observed in 15.2% of the 381 patients. Significant preoperative predictors included American Society of Anesthesiologists (ASA) classification ≥ 3 (p = 0.021), C-reactive protein (CRP) ≥ 20 mg/L (p = 0.004), white blood cell count (WBC) ≥ 15,000/µL (p = 0.003) and forced expiratory volume in 1 s (FEV1) < 50% (p = 0.004). Intraoperative risk factors included thoracotomy (THT) (p = 0.001) and duration of operation > 180 min (p = 0.002). Postoperative predictors included Intensive Care Unit (ICU) admission (p < 0.001) and mechanical ventilation > 24 h (p < 0.001). PP was associated with a higher perioperative mortality rate (10.3% vs. 1.2%, p = 0.01) and prolonged hospital stay. Conclusions: A number of risk factors for the development of PP have been identified, which may help to reduce the incidence of the condition. For further validation, multicenter studies are required. Full article

Background: Frailty is a key determinant of outcomes in critically ill elderly patients, but data from Portugal remain limited. To our knowledge, this is the first study to examine the prevalence and prognostic impact of frailty among elderly ICU patients in a Portuguese hospital setting. Objective: To determine the prevalence of frailty among elderly patients admitted to an intensive care unit (ICU) in southern Portugal and to examine its crude associations with illness severity, organ support, and mortality outcomes. Methods: We conducted a retrospective cohort study including 125 patients aged ≥ 65 years admitted to the polyvalent ICU of Hospital de Faro over the last six months of 2024. Data included demographics, comorbidities, Charlson Comorbidity Index (CCI), severity scores (SOFA, SAPS II, APACHE II), and frailty status assessed by the Clinical Frailty Scale (CFS). Outcomes were the need for organ support, ICU and hospital mortality, and length of stay. Results: Frailty (CFS ≥ 5) was identified in 30.4% of patients. Frail patients were older, had higher comorbidity burden (CCI), and presented with significantly higher severity scores at admission. They also required more invasive support, including vasopressors and invasive mechanical ventilation, while acute kidney injury (AKI) requiring renal replacement therapy (RRT) was similar between groups. ICU mortality was significantly higher among frail patients (50.0% vs. 31.0%), as was hospital mortality (76.3% vs. 33.3%). Length of ICU stay did not differ, although frail patients tended to have longer hospitalizations overall. Conclusions: Frailty was highly prevalent and strongly associated with increased severity, greater need for organ support, and higher mortality. Routine frailty assessment at ICU admission may enhance prognostic accuracy and support patient-centered decision-making. Full article

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and may influence the outcome of critical illness. Although abnormal liver function tests (LFTs) are frequent in the intensive care unit (ICU), the contribution of MASLD to organ-specific hepatic vulnerability and mortality remains unclear. This study aimed to evaluate whether pre-existing metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with baseline and new-onset liver function test (LFT) abnormalities and with intensive care unit (ICU) outcomes in non-cirrhotic medical ICU patients. Materials and Methods: We conducted a retrospective cohort study of adult non-cirrhotic patients admitted to a tertiary medical ICU between December 2020 and December 2023, who underwent hepatobiliary ultrasonography within six months before admission. MASLD was defined as hepatic steatosis with ≥1 cardiometabolic risk factor. The baseline and 72 h LFTs, injury patterns, and ICU outcomes were compared between MASLD and non-MASLD patients. Logistic regression was used to identify the independent predictors of new-onset LFT elevation and ICU mortality. Results: Among 609 patients, MASLD was diagnosed in 240 (39.4%). LFT elevation at admission was more frequent in patients with MASLD (52% vs. 39%, p = 0.03), driven mainly by higher alkaline phosphatase (ALP). At 72 h, ALP (96 [67–146] vs. 85 [60–137]) and gamma-glutamyl transferase (GGT) (50 [27–123] vs. 42 [20–100]) levels remained higher in patients with MASLD (p < 0.01), although rates of new-onset LFT elevation were similar (p > 0.05). Compared to non-MASLD patients, those with MASLD more often required invasive mechanical ventilation (IMV) (64% vs. 33%), central venous catheterization (70% vs. 44%), CRRT (28% vs. 10%), blood product replacement (50% vs. 28%), and developed nosocomial infections (44% vs. 29%) (p < 0.05 for all); however, MASLD was not an independent predictor of mortality. The independent risk factors for mortality were IMV, shock, and higher APACHE II scores. Conclusions: common among medical ICU patients and is associated with a cholestatic biochemical profile and poor ICU outcomes. However, early hepatic injury and ICU mortality are primarily determined by systemic severity and organ support requirements, not the MASLD itself. Full article

Background and Objectives: Driving pressure (DP) and components of mechanical power (MP) have been proposed as prognostic markers in ARDS. The prognostic significance of these parameters in COVID-19–associated ARDS (C-ARDS), particularly during the early phase of intensive care unit (ICU) stay, remains uncertain. Materials and Methods: A retrospective single-center cohort of 310 C-ARDS patients receiving invasive mechanical ventilation was analyzed. Ventilator data from the first 72 h after ICU admission were retrieved. DP, total mechanical power (MPtot), and dynamic mechanical power (MPdyn) were calculated. The primary endpoint was defined as ICU mortality; secondary endpoints were ventilator-free days (VFDs) and length of stay (LOS) in ICU. ROC analyses, Cox proportional hazards regression, and Kaplan–Meier survival estimates were applied. Results: DP ≥ 15.72 cm H₂O and MPdyn ≥ 10.08 J/min were found to be significantly associated with increased ICU mortality (HR 1.9 [1.5–2.5], p < 0.0001; HR 1.5 [1.2–1.9], p = 0.0036, respectively), whereas MPtot ≥ 18.6 J/min was not (p = 0.1). Patients with DP below the threshold demonstrated longer VFDs, and higher survival probabilities. No significant differences in VFDs were identified for MPdyn or MPtot. Conclusions: In C-ARDS patients, early measurements of DP and MPdyn were independently associated with ICU mortality, while MPtot was not. Among these parameters, DP may be regarded as the most practical marker due to its ease of calculation and potential utility in guiding lung-protective ventilation strategies. Full article

Background: Spontaneous ventilation with intubation (SVI) during video-assisted thoracoscopic surgery (VATS) has been introduced as a hybrid technique that combines the physiological benefits of spontaneous breathing with the safety of a secured airway. However, its application in patients with chronic obstructive pulmonary disease (COPD) remains controversial due to concerns about hypercapnia, hypoxemia, and dynamic hyperinflation. To date, no study has directly compared COPD and non-COPD patients undergoing VATS lobectomy under SVI using identical anesthetic and surgical protocols. Methods: A prospective observational study was conducted between January 2022 and December 2024 at a single tertiary thoracic surgery center. A total of 36 patients undergoing elective VATS lobectomy with SVI were included and divided into two groups: COPD (n = 17) and non-COPD (n = 19), based on GOLD criteria. All patients were intubated with a double-lumen tube and allowed to maintain spontaneous ventilation during one-lung ventilation (OLV) after recovery from neuromuscular blockade. Arterial blood gas (ABG) samples were collected at four predefined time points (T1–T4), and intraoperative respiratory parameters, hemodynamics, spontaneous ventilation time, and spontaneous ventilation fraction (SpVent%) were recorded. Postoperative outcomes, including ICU stay, complications, and conversion to controlled ventilation, were analyzed. Statistical comparisons were performed using t-test, Mann–Whitney U test, chi-square test, and ANCOVA with adjustment for age, sex, BMI, and FEV₁%. Results: All 36 procedures were successfully completed under SVI without conversion to controlled mechanical ventilation or thoracotomy. Baseline demographics were comparable between COPD and non-COPD patients regarding age (68.4 ± 6.9 vs. 67.8 ± 7.1 years; p = 0.78) and BMI (27.1 ± 4.6 vs. 26.3 ± 4.2 kg/m²; p = 0.56), while pulmonary function was significantly lower in COPD patients (FEV₁/FVC 53.8% (IQR 47.5–59.9) vs. 82.4% (78.5–85.2); p < 0.001). The duration of spontaneous ventilation was significantly longer in the COPD group (82 ± 14 min vs. 58 ± 16 min; p < 0.001), and remained significant after ANCOVA adjustment (β = +23.7 min; p = 0.001). The SpontVent% was higher in COPD patients (80% [70–90] vs. 60% [45–80]), showing a trend toward significance (p = 0.11). Intraoperative permissive hypercapnia was well tolerated: peak PaCO₂ levels at T3 were higher in COPD (52 ± 6 mmHg) than in non-COPD patients (47 ± 5 mmHg; p = 0.06), without pH dropping below 7.25 in either group. No significant differences were observed in mean arterial pressure, oxygen saturation, ICU stay (1.1 ± 0.4 vs. 1.0 ± 0.5 days; p = 0.48), or postoperative complication rates (p = 0.67). All patients were extubated in the operating room. Conclusions: Intubated spontaneous ventilation during VATS lobectomy is feasible and safe in both COPD and non-COPD patients when performed by experienced teams. COPD patients, despite impaired baseline lung function, were able to maintain spontaneous breathing for significantly longer periods without developing severe hypercapnia, acidosis, or hemodynamic instability. These findings suggest that SVI may represent a lung-protective alternative to fully controlled one-lung ventilation, particularly in hypercapnia-adapted COPD patients. Further multicenter studies are warranted to validate these results and define standardized thresholds for CO₂ tolerance, patient selection, and intraoperative monitoring during SVI. Full article

Background: Discontinuing mechanical ventilation during cardiopulmonary bypass (CPB) is common but may adversely affect postoperative pulmonary function. This study aimed to evaluate the impact of stopping ventilation during CPB on postoperative gas exchange, radiographic findings, intensive care unit (ICU) length of stay (LOS), mortality, reintubation, re-exploration, and bleeding. Methods: A prospective observational study was performed involving adult patients scheduled for elective cardiac surgery requiring CPB. Participants were divided into ventilated and non-ventilated groups according to intraoperative strategy. Postoperative arterial carbon dioxide levels (PaCO₂), arterial partial pressure of oxygen (PaO₂), the PaO₂/FiO₂ ratio (P/F ratio), arterial oxygen saturation (SaO₂), and the ratio of PaCO₂ to minute ventilation (PaCO₂/MV) were measured before the induction of anesthesia (within 5 min after transportation into the operating room), postoperatively within 5–10 min after transportation to the ICU, and in a 24 h postoperative period. Chest X-ray data, mechanical ventilation time, LOS in ICU, re-exploration, reintubation, and bleeding parameters were documented. Analyses were also conducted with the estimation of the age effect and BMI. Results: Individuals in the non-ventilated group exhibited lower postoperative P/F ratios and elevated postoperative PaCO₂ and PaCO₂/MV ratios. The difference in gas exchange leveled off within 24 h. There was no difference in the incidence of atelectasis (postoperatively in a 24 h period), mechanical ventilation time, LOS in ICU, or mortality. However, the incidence of bleeding was higher in the non-ventilated group (χ² = 5.78, p = 0.016). Interestingly, postoperative PaCO₂ and PaCO₂/MV peaked in the 50-year age group. Conclusions: Continued mechanical ventilation during CPB correlates with better postoperative gas exchange, better CO₂ clearance, and fewer bleeding events. The results suggest that maintaining low tidal volume ventilation during CPB may provide benefits, especially for patients aged 50 years. Full article

Background: Ventilator-associated pneumonia (VAP) is a prevalent and serious complication of invasive mechanical ventilation (MV), contributing to significant mortality and increased healthcare resource utilization. While numerous oropharyngeal interventions exist, their comparative efficacy across critical outcomes remains uncertain due to a lack of direct comparisons in clinical trials. Methods: We conducted a systematic review and network meta-analysis (NMA) with a comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL up to September 2025 for randomized and non-randomized studies comparing topical oral interventions in intubated patients. The primary outcome was VAP incidence; secondary outcomes were intensive care unit (ICU) mortality, duration of MV, and ICU length of stay (LOS). Pairwise and network meta-analyses were performed, and the certainty of evidence was assessed. The effect estimates were odds ratios (OR) for categorical outcomes and mean difference (MD) for numerical outcomes represented with 95% confidence intervals (95% CI). Results: Ninety-six studies (20,650 patients) were included, evaluating 44 interventions. For VAP prevention, several interventions were superior to reference/control, including Antimicrobial combinations (OR: 0.21, 95% CI: 0.05–0.39), Povidone-iodine (OR: 0.47, 95% CI: 0.21–0.98), and Chlorhexidine (OR 0.61, 95% CI 0.39–0.95). However, only Chlorhexidine plus toothbrushing significantly reduced mortality (OR: 0.74, 95% CI: 0.58–0.93). For resource utilization, only antimicrobial combinations significantly reduced the duration of MV (MD: −5.55 days, 95% CI: −10.75–−1.7) and ICU LOS (MD: −7.74 days, 95% CI: −13–−4). Evidence certainty (GRADE) was moderate for chlorhexidine and very low for other comparisons. Conclusions: This NMA demonstrates that while multiple oropharyngeal interventions are effective for VAP prevention, their benefits are outcome specific. The choice of intervention should be guided by clinical priorities, as the most effective strategy for preventing VAP may not concurrently reduce mortality or resource use. These findings can inform guideline development and underscore the need for standardized, multi-faceted oral care protocols in the ICU. Full article

Background/Objectives: Iron deficiency is a common condition in the general population, with a higher incidence in critically ill patients. Anemia associated with these alterations is linked to increased morbidity and mortality in ICU patients. This pilot study explores whether provisional CRP and ferritin thresholds might relate to survival, and examines the preliminary associations with analytical and clinical variables in critically ill patients. Methods: A prospective, observational pilot study was conducted on 75 ICU patients over three months. Hematological and biochemical parameters (CRP, ferritin, iron, transferrin, hemoglobin) were analyzed at admission, 48 h, and on days 4 and 7. Clinical data included age, sex, ICU stay, survival, SOFA and APACHE II scores, complications (AKI, acute lung injury), and interventions (mechanical ventilation, infections). Data were analyzed using mixed regression models and Wilcoxon tests. Results: In this pilot cohort (mean age 53.65 years; 61.33% male), survival was 82.67%. Higher CRP and ferritin levels were observed among non-survivors and those with AKI p < 0.05. A CRP level ≥145 mg/L was associated with a constellation of more unfavorable clinical indicators (older age, longer ICU stay, higher APACHE II and SOFA scores, more mechanical ventilation, higher AKI and infection rates, and reduced survival) p < 0.05. Ferritin levels were higher in males and non-survivors and showed positive correlations with SOFA score and ICU length of stay. The exploratory prognostic performance of the CRP threshold was AUC = 0.8103. Conclusions: Elevated CRP and ferritin concentrations were associated with reduced survival probability and indicators of greater clinical severity in critically ill patients. The provisional thresholds identified in this pilot study (CRP ≥ 145 mg/L, ferritin ≥ 300 ng/mL) may facilitate early risk stratification; however, these findings remain exploratory and require validation in larger, multicenter cohorts before clinical translation. Full article

Background: Hospital-acquired disability (HAD), defined as a decline in activities of daily living (ADL) during hospitalization, is a significant component of post-intensive care syndrome (PICS) and may influence long-term outcomes in critically ill patients. Its impact on post-discharge functional recovery, especially among patients who appear ADL-independent at discharge, remains unclear. Methods: This analysis of the multicenter prospective J-RELIFE cohort included 357 ICU patients aged ≥ 40 years who required mechanical ventilation for ≥48 h. The primary outcome was global functional decline, defined as a Kihon Checklist (KCL) score ≥ 8 at 3 months after hospital discharge. Multivariable logistic regression and Cox proportional hazards models were used to identify independent predictors of functional decline, including HAD (Δ Barthel Index ≥ 5), age ≥ 65 years, and psychological distress at discharge (Hospital Anxiety and Depression Scale ≥ 8). Results: Global functional decline at three months was observed in 45% of patients. In logistic regression analysis, HAD (OR = 1.80, 95% CI: 1.00–3.24, p = 0.049), psychological distress (OR = 2.11, 95% CI: 1.27–3.49, p = 0.004), and older age (OR = 1.03 per year, p = 0.027) were independently associated with the outcome. Relative risk analysis confirmed similar associations: HAD (RR = 1.99, 95% CI: 1.71–2.31), psychological distress (RR = 1.35), and their combination significantly increased the risk of functional decline. Among patients who were ADL-independent at discharge (Barthel Index ≥ 85), those with all three risk factors had a markedly elevated risk (RR = 10.17, 95% CI: 6.46–16.00, p < 0.001). Conclusions: HAD, older age, and psychological distress at discharge are robust predictors of functional decline after ICU discharge, even in patients who appear functionally independent at discharge. These findings support comprehensive discharge planning that incorporates both physical and psychological assessments to identify high-risk individuals and improve long-term outcomes. Full article