Abstract
Intensive care unit (ICU) admissions have increased considerably in the last decade. A group of patients that remains poorly characterized are the ones who die within the first 24 hours following ICU admission. Given the significant resources involved in the admission to an ICU, early mortality, represents a high cost to benefit ratio. Building upon the findings of our recently published audit in a Portuguese tertiary ICU, this commentary explores the multifactorial nature of early ICU mortality. It highlights challenges in pre-admission triage, delayed recognition of clinical deterioration, prognostic complexity in frail elderly patients, and ethical tensions surrounding end-of-life care. Through integration of evidence-based data and recent literature, we argue for a structured, multidisciplinary approach that includes rapid response systems, frailty-adjusted triage tools, early palliative intervention, and robust ethical frameworks. The goal is to move beyond reactive critical care and toward anticipatory models that better balance clinical effectiveness with humane practice.