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

Tracey H Fan; Merry Huang; Aron Gedansky; Carrie Price; Chiara Robba; Adrian V Hernandez; Sung-Min Cho

doi:10.1007/s00408-021-00491-1

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

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

Authors

Tracey H Fan¹, Merry Huang², Aron Gedansky², Carrie Price³, Chiara Robba⁴, Adrian V Hernandez^{5

6}, Sung-Min Cho⁷

Affiliations

¹ Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
² Department of Neurology, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA.
³ Albert S. Cook Library, Towson University, Towson, MD, USA.
⁴ Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
⁵ Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Mansfield, CT, USA.
⁶ Unidad de Revisiones Sistemáticas y Meta-Análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru.
⁷ Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Johns Hopkins University, 600 N. Wolfe Street, Phipps 455, Baltimore, MD, 21287, USA. csungmi1@jhmi.edu.

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.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adolescent
Adult
Brain Injuries, Traumatic* / complications
Brain Injuries, Traumatic* / epidemiology
Brain Injuries, Traumatic* / therapy
Case-Control Studies
Cohort Studies
Female
Humans
Male
Prevalence
Respiratory Distress Syndrome* / diagnosis
Respiratory Distress Syndrome* / epidemiology
Respiratory Distress Syndrome* / etiology