Factors associated with acute respiratory distress syndrome in brain-injured patients: A systematic review and meta-analysis.

Autor: Taran S; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA. Electronic address: Shaurya.taran@mail.utoronto.ca., Hamad DM; Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada., von Düring S; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Intensive Care Division, Geneva University Hospitals (HUG) and Faculty of Medicine, University of Geneva, Switzerland., Malhotra AK; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada., Veroniki AA; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada., McCredie VA; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada., Singh JM; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada., Hansen B; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands., Englesakis M; Library and Health Information Services, University Health Network, Toronto, ON, Canada., Adhikari NKJ; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2023 Oct; Vol. 77, pp. 154341. Date of Electronic Publication: 2023 May 24.
DOI: 10.1016/j.jcrc.2023.154341
Abstrakt: Purpose: Acute respiratory distress syndrome (ARDS) is common in patients with acute brain injury admitted to the ICU. We aimed to identify factors associated with ARDS in this population.
Methods: We searched MEDLINE, Embase, Cochrane Central, Scopus, and Web of Science from inception to January 14, 2022. Three reviewers independently screened articles and selected English-language studies reporting risk factors for ARDS in brain-injured adult patients. Data were extracted on ARDS incidence, adjusted and unadjusted risk factors, and clinical outcomes. Risk of bias was reported using the Quality in Prognostic Studies tool. Certainty of evidence was assessed using GRADE.
Results: We selected 23 studies involving 6,961,284 patients with acute brain injury. The pooled cumulative incidence of ARDS after brain injury was 17.0% (95%CI 10.7-25.8). In adjusted analysis, factors associated with ARDS included sepsis (odds ratio (OR) 4.38, 95%CI 2.37-8.10; high certainty), history of hypertension (OR 3.11, 95%CI 2.31-4.19; high certainty), pneumonia (OR 2.69, 95%CI 2.35-3.10; high certainty), acute kidney injury (OR 1.44, 95%CI 1.30-1.59; moderate certainty), admission hypoxemia (OR 1.67, 95%CI 1.29-2.17; moderate certainty), male sex (OR 1.30, 95%CI 1.06-1.58; moderate certainty), and chronic obstructive pulmonary disease (OR 1.27, 95%CI 1.13-1.44; moderate certainty). Development of ARDS was independently associated with increased odds of in-hospital mortality (OR 3.12, 95% CI 1.39-7.00).
Conclusions: Multiple risk factors are associated with ARDS in brain-injured patients. These findings could be used to develop prognostic models for ARDS or as prognostic enrichment strategies for patient enrolment in future clinical trials.
Competing Interests: Declaration of Competing Interest All authors declare they have no competing interests relevant to the submitted work. None of the authors have any financial or non-financial conflicts of interests related to the present manuscript.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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