Work

Characterization and 3-Year Survival of Clinical Subtypes and Host Response Phenotypes of Acute Respiratory Failure Requiring Mechanical Ventilation

Year: 2026

Type: article

Abstract: BACKGROUND: Acute respiratory failure (ARF) requiring invasive mechanical ventilation affects approximately 1.5 million adults in the United States annually. Whereas ARDS is well characterized, non-ARDS ARF-comprising most patients who are mechanically ventilated-lacks systematic characterization of clinical features, biological profiles, and long-term outcomes. RESEARCH QUESTION: How do ARF subtypes differ in clinical, physiologic, and biological characteristics and in long-term survival? STUDY DESIGN AND METHODS: Prospective cohort study of 826 mechanically ventilated adults enrolled at a single academic center from 2011 through 2024. Patients were classified systematically into 7 predefined ARF subtypes using consensus methodology. We compared physiologic features, biological subphenotypes, and 3-year survival. RESULTS: < .01), predominantly in patients with ARDS and ARFA, whereas patients with other subtypes showed minimal subphenotype-associated survival differences. INTERPRETATION: Our results show that patients who are mechanically ventilated with ARF demonstrate marked heterogeneity in physiologic features, biology, and long-term outcomes. Overall, fewer than one-half of patients survived to 3 years, but survival varied markedly across clinical subtypes beyond traditional ARDS categorization. Clinical subtype classification identifies distinct populations with divergent long-term prognoses, providing information complementary to biological subphenotyping. These findings provide quantitative outcome data to support prognostic counseling and to establish a reproducible framework for clinical research in ARF resulting from heterogeneous causes.

Source: CHEST Critical Care

DOI: 10.1016/j.chstcc.2026.100274