Background: Over the past decade, numerous studies on potential factors contributing to ventilation-induced lung injury have been carried out. Mechanical power has been pointed out as the parameter that encloses all ventilation-induced lung injury-contributing factors. However, studies conducted to date provide data regarding mechanical power during the early hours of mechanical ventilation that may not accurately reflect the impact of power throughout the period of mechanical ventilatory support on intensive care unit mortality. Methods: Retrospective observational study conducted at a single center in Spain. Patients admitted to the intensive care unit, > o = 18 years of age, and ventilated for over 24 h were included. We extracted the mechanical power values throughout the entire mechanical ventilation in controlled modes period from the clinical information system every 2 min. First, we calculate the cutoff-point for mechanical power beyond which there was a greater change in the probability of death. After, the sum of time values above the safe cut-off point was calculated to obtain the value in hours. We analyzed if the number of hours the patient was under ventilation with a mechanical power above the safe threshold was associated with intensive care unit mortality, invasive mechanical ventilation days, and intensive care unit length of stay. We repeated the analysis in different subgroups based on the degree of hypoxemia and in patients with SARS CoV-2 pneumonia. Results: The cut-off point of mechanical power at with there is a higher increase in intensive care unit mortality was 18 J/min. The greater the number of hours patients were under mechanical power > 18 J/min the higher the intensive care unit mortality in all the study population, in patients with SARS CoV-2 pneumonia and in mild to moderate hypoxemic respiratory failure. The risk of death in the intensive care unit increases 0.1% for each hour with mechanical power exceeding 18 J/min. The number of hours with mechanical power > 18 J/min also affected the days of invasive mechanical ventilation and intensive care unit length of stay. Conclusions: The number of hours with mechanical power > 18 J/min is associated with mortality in the intensive care unit in critically ill patients. Continuous monitoring of mechanical power in controlled modes using an automated clinical information system could alert the clinician to this risk.

Background: The optimal time to intubate patients with SARS-CoV-2 pneumonia has not been adequately determined. While the use of non-invasive respiratory support before invasive mechanical ventilation might cause patient-self-induced lung injury and worsen the prognosis, non-invasive ventilation (NIV) is frequently used to avoid intubation of patients with acute respiratory failure (ARF). We hypothesized that delayed intubation is associated with a high risk of mortality in COVID-19 patients. Methods: This is a secondary analysis of prospectively collected data from adult patients with ARF due to COVID-19 admitted to 73 intensive care units (ICUs) between February 2020 and March 2021. Intubation was classified according to the timing of intubation. To assess the relationship between early versus late intubation and mortality, we excluded patients with ICU length of stay (LOS) < 7 days to avoid the immortal time bias and we did a propensity score and a cox regression analysis. Results: We included 4,198 patients [median age, 63 (54‒71) years; 71% male; median SOFA (Sequential Organ Failure Assessment) score, 4 (3‒7); median APACHE (Acute Physiology and Chronic Health Evaluation) score, 13 (10‒18)], and median PaO₂/FiO₂ (arterial oxygen pressure/ inspired oxygen fraction), 131 (100‒190)]; intubation was considered very early in 2024 (48%) patients, early in 928 (22%), and late in 441 (10%). ICU mortality was 30% and median ICU stay was 14 (7‒28) days. Mortality was higher in the “late group” than in the “early group” (37 vs. 32%, p < 0.05). The implementation of an early intubation approach was found to be an independent protective risk factor for mortality (HR 0.6; 95%CI 0.5‒0.7). Conclusions: Early intubation within the first 24 h of ICU admission in patients with COVID-19 pneumonia was found to be an independent protective risk factor of mortality. Trial registration: The study was registered at Clinical-Trials.gov (NCT04948242) (01/07/2021).

Invasive Mechanical Ventilation (IMV) in Intensive Care Units (ICU) significantly increases the risk of Ventilator-Induced Lung Injury (VILI), necessitating careful management of mechanical power (MP). This study aims to develop a real-time predictive model of MP utilizing Artificial Intelligence to mitigate VILI. A retrospective observational study was conducted, extracting patient data from Clinical Information Systems from 2018 to 2022. Patients over 18 years old with more than 6 h of IMV were selected. Continuous data on IMV variables, laboratory data, monitoring, procedures, demographic data, type of admission, reason for admission, and APACHE II at admission were extracted. The variables with the highest correlation to MP were used for prediction and IMV data was grouped in 15-minute intervals using the mean. A mixed neural network model was developed to forecast MP 15 min in advance, using IMV data from 6 h before the prediction and current patient status. The model's ability to predict future MP was analyzed and compared to a baseline model predicting the future value of MP as equal to the current value. The cohort consisted of 1967 patients after applying inclusion criteria, with a median age of 63 years and 66.9 % male. The deep learning model achieved a mean squared error of 2.79 in the test set, indicating a 20 % improvement over the baseline model. It demonstrated high accuracy (94 %) in predicting whether MP would exceed a critical threshold of 18 J/min, which correlates with increased mortality. The integration of this model into a web platform allows clinicians real-time access to MP predictions, facilitating timely adjustments to ventilation settings. The study successfully developed and integrated in clinical practice a predictive model for MP. This model will assist clinicians allowing for the adjustment of ventilatory parameters before lung damage occurs.

Background: The Patient Outcome Assessment and Decision Support (PADS) model is a real-time framework designed to predict both mortality and the likelihood of discharge within 48 h in critically ill patients. By combining these predictions, PADS enables clinically meaningful stratification of patient trajectories, supporting bedside decision-making and the planning of critical care resources such as nursing allocation and surgical scheduling. Methods: PADS integrates routinely collected clinical data: SOFA variables, age, gender, admission type, and comorbidities. It consists of two Long Short-Term Memory (LSTM) neural networks—one predicting the probability of death and the other the probability of discharge within 48 h. The combination places each patient into one of four states: alive/discharged within 48 h, alive/not discharged, dead within 48 h, or dead later. The model was trained using MIMIC-IV data, emphasizing ease of implementation in units with electronic health records. Out of the 76,540 stays present in MIMIC-IV (53,150 patients), 32,875 (25,555 patients) were used after excluding those with short stays (<48 h) or life support treatment limitations. The code is open, well-documented, and designed for reproducibility and external validation. Results: The model achieved strong performance: AUCROC of 0.94 (±0.03) for mortality and 0.89 (±0.07) for discharge on training data, and 0.87 (±0.02) and 0.88 (±0.03), respectively, on the test set. As a comparison, benchmark models obtain worse accuracy (−13.4% for APS III, −19% for OASIS, and −7.4% for SAPS II). Predictions are visualized in an intuitive format to support clinical interpretation. Conclusions: PADS offers a transparent, reproducible, and practical tool that supports both individual patient care and the strategic organization of intensive care resources by anticipating short-term outcomes.

BackgroundOptimal time to intubate patients with SARS-CoV-2 pneumonia is controversial. Whereas some authors recommend trying noninvasive respiratory support before intubate, others argue that delaying intubation can cause patient-self-induced lung injury and worsen the prognosis. We hypothesized that delayed intubation would increase the risk mortality in COVID-19 patients.MethodsThis preplanned retrospective observational study used prospectively collected data from adult patients with COVID-19 and respiratory failure admitted to 73 intensive care units between February 2020 and March 2021. Patients with limitations on life support and those with missing data were excluded.We collected demographic, laboratory, clinical variables and outcomes.Intubation was classified as 1) Very early: before or at ICU admission; 2) Early: < 24 hours after ICU admission; or 3) Late: ≥24 hours after ICU admission. We compared the early group versus those intubated late, using chi-square tests for categorical variables and the Mann-Whitney U for continuous variables. To assess the relationship between early versus late intubation and mortality, we used multivariable binary logistic regression. Statistical significance was set at p<0.05.Results We included 4198 patients [median age, 63 (54‒71) years; 70.8% male; median SOFA score, 4 (3‒7); median APACHE score, 13 (10‒18)], and median PaO₂/FiO₂, 131 (100‒190)]; intubation was very early in 2024 (48.2%) patients, early in 928 (22.1%), and late in 441 (10.5%). ICU mortality was 30.2% and median ICU stay was 14 (7‒28) days. Although patients in the late group were younger [62 vs. 64, respectively, p<0.05] and had less severe disease [APACHE II (13 vs. 14, respectively, p<0.05) and SOFA (3 vs. 4, respectively, p<0.05) scores], and higher PaO2/FiO₂ at admission (116 vs. 100, respectively, p<0.05), mortality was higher in the late group than in the early group (36.9% vs. 31.6%, p<0.05). Late intubation was independently associated with mortality (OR1.83; 95%CI 1.35‒2.47).ConclusionsDelaying intubation beyond the first 24 hours of admission in patients with COVID-19 pneumonia increases the risk of mortality. Trial registration: The study was retrospectively registered at Clinical-Trials.gov (NCT 04948242) on the 30^th June 2021.