TY - JOUR
T1 - Prevalence and Outcome of Acute Respiratory Distress Syndrome in Traumatic Brain Injury
T2 - A Systematic Review and Meta-Analysis
AU - Fan, Tracey H.
AU - Huang, Merry
AU - Gedansky, Aron
AU - Price, Carrie
AU - Robba, Chiara
AU - Hernandez, Adrian V.
AU - Cho, Sung Min
N1 - Funding Information:
None.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021/12
Y1 - 2021/12
N2 - Objectives: Acute respiratory distress syndrome (ARDS) in patients with traumatic brain injury (TBI) is associated with increased mortality. Information on the prevalence of ARDS and its neurological outcome after TBI is sparse. We aimed to systematically review the prevalence, risk factors, and outcome of ARDS in TBI population. Data Sources: PubMed and four other databases (Embase, Cochrane Library, Web of Science Core Collection, and Scopus) from inception to July 6, 2020. Study Selection: Randomized controlled trials (RCTs) and observational studies in patients older than 18 years old. Data Extraction: Two independent reviewers extracted the data. Study quality was assessed by the Cochrane Risk of Bias tool for RCTs, the Newcastle–Ottawa Scale for cohort and case–control studies. Good neurological outcome was defined as Glasgow Outcome Scale ≥ 4. Random-effects meta-analyses were conducted to estimate pooled outcome prevalence and their 95% confidence intervals (CI). Data Synthesis: We included 20 studies (n = 2830) with median age of 44 years (interquartile range [IQR] = 35–47, 64% male) and 79% (n = 2237) suffered severe TBI. In meta-analysis, 19% patients (95% CI = 0.13–0.27, I2 = 93%) had ARDS after TBI. The median time from TBI to ARDS was 3 days (IQR = 2–5). Overall survival at discharge for the TBI cohort was 70% (95% CI = 0.64–0.75; I2 = 85%) and good neurological outcome at any time was achieved in 31% of TBI patients (95% CI = 0.23–0.40; I2 = 88%). TBI cohort without ARDS had higher survival (67% vs. 57%, p = 0.01) and good neurological outcomes (34% vs. 23%, p = 0.02) compared to those with ARDS. We did not find any specific risk factors for developing ARDS. Conclusion: In this meta-analysis, approximately one in five patients had ARDS shortly after TBI with the median time of 3 days. The presence of ARDS was associated with worse neurological outcome and mortality in TBI. Further research on prevention and intervention strategy of TBI-associated ARDS is warranted.
AB - Objectives: Acute respiratory distress syndrome (ARDS) in patients with traumatic brain injury (TBI) is associated with increased mortality. Information on the prevalence of ARDS and its neurological outcome after TBI is sparse. We aimed to systematically review the prevalence, risk factors, and outcome of ARDS in TBI population. Data Sources: PubMed and four other databases (Embase, Cochrane Library, Web of Science Core Collection, and Scopus) from inception to July 6, 2020. Study Selection: Randomized controlled trials (RCTs) and observational studies in patients older than 18 years old. Data Extraction: Two independent reviewers extracted the data. Study quality was assessed by the Cochrane Risk of Bias tool for RCTs, the Newcastle–Ottawa Scale for cohort and case–control studies. Good neurological outcome was defined as Glasgow Outcome Scale ≥ 4. Random-effects meta-analyses were conducted to estimate pooled outcome prevalence and their 95% confidence intervals (CI). Data Synthesis: We included 20 studies (n = 2830) with median age of 44 years (interquartile range [IQR] = 35–47, 64% male) and 79% (n = 2237) suffered severe TBI. In meta-analysis, 19% patients (95% CI = 0.13–0.27, I2 = 93%) had ARDS after TBI. The median time from TBI to ARDS was 3 days (IQR = 2–5). Overall survival at discharge for the TBI cohort was 70% (95% CI = 0.64–0.75; I2 = 85%) and good neurological outcome at any time was achieved in 31% of TBI patients (95% CI = 0.23–0.40; I2 = 88%). TBI cohort without ARDS had higher survival (67% vs. 57%, p = 0.01) and good neurological outcomes (34% vs. 23%, p = 0.02) compared to those with ARDS. We did not find any specific risk factors for developing ARDS. Conclusion: In this meta-analysis, approximately one in five patients had ARDS shortly after TBI with the median time of 3 days. The presence of ARDS was associated with worse neurological outcome and mortality in TBI. Further research on prevention and intervention strategy of TBI-associated ARDS is warranted.
KW - Acute brain injury
KW - Acute lung injury
KW - Acute respiratory distress syndrome
KW - Neurogenic pulmonary edema
KW - Traumatic brain injury
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U2 - 10.1007/s00408-021-00491-1
DO - 10.1007/s00408-021-00491-1
M3 - Article
C2 - 34779897
AN - SCOPUS:85119133690
SN - 0341-2040
VL - 199
SP - 603
EP - 610
JO - Pneumonologie. Pneumonology
JF - Pneumonologie. Pneumonology
IS - 6
ER -