Respiratory failure & ventilation
Reproducible clinical archetypes in acute respiratory failure: a multi-cohort trajectory analysis
Authors' conclusion
Four reproducible oxygenation archetypes capture the 14-day course of persistent respiratory failure.
Study context
- Population
- Adults with persistent acute hypoxemic respiratory failure (AHRF) (PaO2/FiO2 < 300 mmHg and PEEP ≥ 5 cmH2O for ≥ 72 h); MIMIC-IV and UK/Netherlands cohortsderivation 3938
- Exposure
- TC1 vs TC2 vs TC3 vs TC4
- Outcome
- Trajectory classes of daily mean PaO2/FiO2 and time to ICU discharge/death
- Follow-up
- Day 14
Methodological detailsderivation and external validation cohorts, competing-risk latent class mixed model
- Derivation and external validation cohorts
- Competing-risk latent class mixed model
Main finding
As reported in the abstract
Four-class trajectory model: 14-day mortality · 14 days
Observational data: associations, not effects.
Further findings
| Outcome | TC2 | TC4 |
|---|---|---|
| Hyperinflammatory subphenotype prevalence | — not stated in the abstract | 41-53% |
| ARDS prevalence | 50% | — not stated in the abstract |
— not stated in the abstract
Hyperinflammatory subphenotype prevalence
- TC4 enriched for hyperinflammatory subphenotype
ARDS prevalence
- TC2 most common in patients with ARDS
Early TC prediction (12-variable XGBoost), external validation · day 3
- Mean AUCs ≥ 0.78 (0.70-0.86)
Other clinical biomarker trajectories
- Distinct patterns between trajectory classes (TCs)
Original publication
Reproducible clinical archetypes in acute respiratory failure: a multi-cohort trajectory analysis. Intensive Care Med. Published 17 May 2026. doi:10.
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