Peter G Szilagyi, Stanley Schaffer, Cynthia M Rand, Phyllis Vincelli, Ashley Eagan, Nicolas P N Goldstein, A Dirk Hightower, Mary Younge, Aaron Blumkin, Christina S Albertin, Byung-Kwang Yoo, Sharon G Humiston
School-Located Influenza Vaccinations: A Randomized Trial
Pediatrics
septic patients develop acute respiratory failure arf requiring mechanical ventilation represent heterogenous subgroup critically ill patients widely variable clinical characteristics identifying distinct phenotypes patients may reveal insights broader heterogeneity clinical course sepsis aimed derive novel phenotypes sepsisinduced arf using observational clinical data investigate generalizability across multiicu specialties considering multiorgan dynamics performed multicenter retrospective study icu patients sepsis required mechanical ventilation 24 hours data two different highvolume academic hospital systems used derivation set n3225 medical icu micu patients validation set n848 micu patients multiicu validation utilized retrospective data two surgical icus hospitals n1577 clinical data 24 hours preceding intubation used derive distinct phenotypes using explainable machine learningbased clustering model interpreted clinical experts four distinct arf phenotypes identified severe multiorgan dysfunction mod high likelihood kidney injury heart failure b severe hypoxemic respiratory failure median pf123 c mild hypoxia median pf240 severe mod high likelihood hepatic injury coagulopathy lactic acidosis patients phenotype showed differences clinical course mortality rates despite similarities demographics admission comorbidities phenotypes reproduced external validation utilizing external micu second hospital sicus centers kaplanmeier analysis showed significant difference 28day mortality across phenotypes p001 consistent across centers phenotypes demonstrated differences treatment effects associated high positive endexpiratory pressure peep strategy phenotypes demonstrated unique patterns organ injury differences clinical outcomes may help inform future research clinical trial design tailored management strategies