{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T18:03:52Z","timestamp":1789581832359,"version":"build-2803163510"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23HL166783"],"award-info":[{"award-number":["K23HL166783"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Persistent critical illness (PerCI) describes patients with prolonged intensive care unit (ICU) dependence after their acute phase of illness and affects 5\u201320% of the general ICU population. PerCI has been studied in the general ICU cohort, but prevalence and outcomes remain unclear among mechanically ventilated patients with acute hypoxic respiratory failure (AHRF), a high-risk cohort that is more prone to ICU-associated complications. The objective of this study is to quantify PerCI prevalence, identify risk factors for PerCI development, and describe one-year mortality in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study of patients with AHRF (PaO2\/FiO2 ratio\u2009&lt;\u2009300) requiring mechanical ventilation within 72 hours of ICU admission across a 12-hospital health system (2011\u20132022). PerCI was defined as ICU length of stay\u2009\u2265\u200910 days. The primary outcome was one-year mortality, modeled using a Cox proportional hazards model with PerCI as a time-varying exposure. To identify risk factors for PerCI while accounting for competing early mortality, we used a dual-model approach: logistic regression comparing PerCI to early death (\u2264 10-day mortality) and PerCI to early ICU discharge, with factors associated with both models considered robust predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 10,626 eligible patients, 3,107 (29.2%) met criteria for PerCI. One-year survival was 64.2% in the PerCI group compared to 73.8% in the non-PerCI group. After PerCI onset, mortality risk increased threefold (hazard ratio 3.01; 95% CI 2.72\u20133.33). Factors consistently associated with PerCI across both models included ARDS, pneumonia, aspiration pneumonitis, heart failure, septic shock, weight loss, surgical admission, and postprocedural respiratory and circulatory failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nearly one in three mechanically ventilated AHRF patients developed PerCI, far exceeding rates in the general ICU populations and was associated with worse one-year survival. Identifiable clinical risk factors may support earlier goals-of-care conversations and post-ICU care planning in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358431","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:36:12Z","timestamp":1789580172000},"page":"e0358431","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent critical illness in acute hypoxic respiratory failure: A retrospective cohort study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6281-0630","authenticated-orcid":true,"given":"Michael","family":"Kalinoski","sequence":"first","affiliation":[{"name":"University of Minnesota Medical School","place":["Minneapolis, Minnesota, United States of America"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Bolden","sequence":"additional","affiliation":[{"name":"University of Minnesota Medical School","place":["Minneapolis, Minnesota, United States of America"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Wang","sequence":"additional","affiliation":[{"name":"Clinical and Translational Science Institute, University of Minnesota","place":["Minneapolis, Minnesota, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Adams","family":"Dudley","sequence":"additional","affiliation":[{"name":"University of Minnesota Medical School","place":["Minneapolis, Minnesota, United States of America"],"department":["Department of Medicine"]},{"name":"Center for Care Delivery and Outcomes Research (CCDOR) VA Minneapolis Healthcare System","place":["Minneapolis, Minnesota, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Mesfin","sequence":"additional","affiliation":[{"name":"University of Minnesota Medical School","place":["Minneapolis, Minnesota, United States of America"],"department":["Department of Medicine"]},{"name":"Center for Care Delivery and Outcomes Research (CCDOR) VA Minneapolis Healthcare System","place":["Minneapolis, Minnesota, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0292-0594","authenticated-orcid":true,"given":"Nicholas E.","family":"Ingraham","sequence":"additional","affiliation":[{"name":"University of Minnesota Medical School","place":["Minneapolis, Minnesota, United States of America"],"department":["Department of Medicine"]},{"name":"Center for Care Delivery and Outcomes Research (CCDOR) VA Minneapolis Healthcare System","place":["Minneapolis, Minnesota, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"2","key":"pone.0358431.ref001","first-page":"110","article-title":"Persistent critical illness: baseline characteristics, intensive care course, and cause of death","volume":"21","author":"JN Darvall","year":"2019","journal-title":"Crit Care Resusc"},{"key":"pone.0358431.ref002","doi-asserted-by":"crossref","first-page":"616694","DOI":"10.3389\/fmed.2020.616694","article-title":"Immunological Endotyping of Chronic Critical Illness After Severe Sepsis","volume":"7","author":"BP Fenner","year":"2021","journal-title":"Front Med (Lausanne)"},{"issue":"3","key":"pone.0358431.ref003","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.ramb.2012.12.002","article-title":"Prediction of chronic critical illness in a general intensive care unit","volume":"59","author":"SH Loss","year":"2013","journal-title":"Rev Assoc Med Bras (1992)"},{"issue":"3","key":"pone.0358431.ref004","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/S0749-0704(02)00015-5","article-title":"The epidemiology and costs of chronic critical illness","volume":"18","author":"SS Carson","year":"2002","journal-title":"Crit Care Clin"},{"issue":"5","key":"pone.0358431.ref005","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1097\/CCM.0b013e3181691a49","article-title":"Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery","volume":"36","author":"MD Zilberberg","year":"2008","journal-title":"Crit Care Med"},{"issue":"1","key":"pone.0358431.ref006","first-page":"87","article-title":"Chronic critical illness: are we saving patients or creating victims?","volume":"29","author":"SH Loss","year":"2017","journal-title":"Rev Bras Ter Intensiva"},{"issue":"4","key":"pone.0358431.ref007","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1164\/rccm.201002-0210CI","article-title":"Chronic critical illness","volume":"182","author":"JE Nelson","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0358431.ref008","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1164\/ajrccm.159.5.9809002","article-title":"Outcomes after long-term acute care. 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