Tracey Fan
Neurocritical Care
Massachusetts General Hospital
Boston, Massachusetts
Disclosure information not submitted.
MERRY HUANG, MD
Neurology Resident
Department of Neurology, Cleveland Clinic, United States
Disclosure information not submitted.
ARON GEDANSKY, MD
Neurology Resident
Department of Neurology, Cleveland Clinic, United States
Disclosure information not submitted.
CARRIE PRICE, MLS
Informational Specialist
Albert S. Cook Library, Towson University, United States
Disclosure information not submitted.
Chiara Robba, MD, PhD
Professor of anesthesia and critical care, neurocritical care attending
San Martino Policlinico Hospital, United States
Disclosure information not submitted.
ADRIAN HERNANDEZ, MD, PhD
Associate Professor of Comparative Effectiveness and Outcomes Research
University of Connecticut School of Pharmacy, Universidad San Ignacio de Loyola (USIL), United States
Disclosure information not submitted.
Sung-Min Cho, DO, MHS
Assistant Professor
Johns Hopkins Hospital, United States
Disclosure information not submitted.
Title: Prevalence and Outcome of Acute Respiratory Distress Syndrome in Traumatic Brain Injury
Introduction: 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.
Method: PubMed and four other databases (Embase, Cochrane Library, Web of Science Core Collection, and Scopus) from inception to July 6, 2020. Randomized controlled trials (RCTs) and observational studies in patients older than 18 years old. 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).
RESULT: We included 21 studies (n=3,203) with median age of 44 years (interquartile range [IQR]=36-48, 66% male) and 70% (n=2,242) suffered severe TBI. In meta-analysis, 21% patients (95% CI=0.14-0.29, I2=95%) 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=0.64-0.76; I2=84%) 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.