Factors associated with acute respiratory distress syndrome in brain-injured patients: A systematic review and meta-analysis |
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| Affiliation: | 1. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada;2. Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA;3. Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada;4. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;5. Intensive Care Division, Geneva University Hospitals (HUG) and Faculty of Medicine, University of Geneva, Switzerland;6. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada;7. Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada;8. Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael''s Hospital, Toronto, ON, Canada;9. Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, ON, Canada;10. Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands;11. Library and Health Information Services, University Health Network, Toronto, ON, Canada;1. FCCM, ICU, CHU UCL Godinne Namur, UCL Louvain Medical Shool, Belgium;2. ULB University, Centre Hospitalier Universitaire Brugmann,Brussels, Belgium;1. Department of Anesthesiology, Intensive Care Medicine and Palliative Care Medicine, Carl-Thiem-Hospital, Cottbus, Germany;2. Department of Anesthesiology and Surgical Intensive Care, University Hospital Halle (Saale), Halle (Saale), Germany;3. Department of Anesthesiology and Intensive Care Medicine, University Hospital Lubeck, Lubeck, Germany;1. SA Pharmacy, Flinders Medical Centre, Bedford Park, SA 5042, Australia;2. College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;3. Division of Critical Care, Department of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and Surgeons, Stamford, CT, United States of America;4. Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium;5. Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia;6. PRI, Los Altos Hills, CA, United States of America;7. Diabetes Research Emeritus, Biomedical Sciences Emeritus, Einstein Diabetes Research Center, Department of Medicine and Pathology Emeritus, Albert Einstein College of Medicine, Bronx, NY, United States of America;8. Division of Metabolism, Endocrinology and Nutrition, University of Washington Medicine Diabetes Institute, Seattle, WA, United States of America;9. Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, United States of America;1. Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye;2. Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye;3. Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye;4. Department of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkiye;5. Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye;6. Department of Nephrology, Firat Medical Faculty, Elazig, Turkiye;7. Department of Intensive Care Unit, Kirsehir Ahi Evran University, Kirsehir, Turkiye;8. Department of Intensive Care Unit, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkiye;9. Department of Nephrology, School of Medicine, Dicle University, Diyarbakır, Turkiye;10. Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye;11. Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye;12. Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye;13. Department of Intensive Care Unit, Health Sciences University, İzmir Dr.Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkiye;14. Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkiye;15. Division of Intensive Care Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkiye;p. Division of Intensive Care Medicine, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkiye;q. Department of Chest Diseases, Selçuk University Faculty of Medicine, Konya, Turkiye;r. Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA;s. Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA;1. Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Lahore 54550, Punjab, Pakistan;1. Intensive Care National Audit and Research Centre, London, United Kingdom;2. Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada;3. Toronto General Hospital, Toronto, Canada |
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| Abstract: | PurposeAcute 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.MethodsWe 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.ResultsWe 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).ConclusionsMultiple 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. |
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