Clinical Research Directory

Inclusion Criteria: * • Age ≥ 18 years of either sex. * Admission to the ICU and receiving invasive mechanical ventilation via endotracheal tube. * Expected duration of mechanical ventilation ≥ 24 hours. * Hemodynamically stable or stabilized at the time of first spontaneous breathing trial (SBT) according to unit protocol (e.g., mean arterial pressure ≥ 65 mmHg with or without low dose vasopressors). * Availability of baseline and daily serum creatinine, urine output, and relevant clinical data to diagnose and stage acute kidney injury according to KDIGO criteria. Exclusion Criteria: * Pre existing end stage renal disease on chronic dialysis (hemodialysis or peritoneal dialysis). * Known advanced chronic kidney disease (e.g., baseline estimated GFR \< 30 mL/min/1.73 m²) if baseline creatinine is available. * Previous tracheostomy before current ICU admission. * Neuromuscular diseases or spinal cord injury causing chronic ventilatory dependence. * Severe pre existing cognitive impairment or brain death at ICU admission. * Do not intubate or comfort care only orders at time of eligibility assessment. * Re intubation after ICU discharge (only the first ICU admission episode will be considered). * Patients or legal representatives refusing or withdrawing consent