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Meta-Analysis
. 2021 Dec;199(6):603-610.
doi: 10.1007/s00408-021-00491-1. Epub 2021 Nov 15.

Prevalence and Outcome of Acute Respiratory Distress Syndrome in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Tracey H Fan  1 , Merry Huang  2 , Aron Gedansky  2 , Carrie Price  3 , Chiara Robba  4 , Adrian V Hernandez  5   6 , Sung-Min Cho  7
Affiliations
Meta-Analysis

Prevalence and Outcome of Acute Respiratory Distress Syndrome in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Tracey H Fan et al. Lung. 2021 Dec.

Abstract

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.

Keywords: Acute brain injury; Acute lung injury; Acute respiratory distress syndrome; Neurogenic pulmonary edema; Traumatic brain injury.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study flowchart for literature search and selection of studies. ARDS acute respiratory distress stress; RCT randomized controlled trials; TBI traumatic brain injury
Fig. 2
Fig. 2
Meta-analysis of the prevalence of ARDS among patients with traumatic brain injury. ARDS acute respiratory distress stress. τ2 is the variance of the effect size parameters across the population of studies and it reflects the variance of the true effect sizes. I2 quantified the degree of heterogeneity across the studies that ranges between 0 and 100%
Fig. 3
Fig. 3
Meta-analysis of overall survival at discharge in patients with traumatic brain injury. τ2 is the variance of the effect size parameters across the population of studies and it reflects the variance of the true effect sizes. I2 quantified the degree of heterogeneity across the studies that ranges between 0 and 100%
Fig. 4
Fig. 4
Meta-analysis of overall good neurological outcomes at any time in patients with traumatic brain injury. τ2 is the variance of the effect size parameters across the population of studies and it reflects the variance of the true effect sizes. I2 quantified the degree of heterogeneity across the studies that ranges between 0 and 100%
See this image and copyright information in PMC

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