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Crit Care Resusc . Mortality associated with acute respiratory distress syndrome, 2009-2019: a systematic review and meta-analysis

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  • Crit Care Resusc . Mortality associated with acute respiratory distress syndrome, 2009-2019: a systematic review and meta-analysis

    Crit Care Resusc


    . 2023 Oct 16;24(4):341-351.
    doi: 10.51893/2022.4.OA4. eCollection 2022 Dec 5. Mortality associated with acute respiratory distress syndrome, 2009-2019: a systematic review and meta-analysis

    Divyajot Sadana 1 , Simrat Kaur 2 , Kesavan Sankaramangalam 3 , Ishan Saini 4 , Kinjal Banerjee 5 , Matthew Siuba 1 , Valentina Amaral 1 , Shruti Gadre 1 , Heather Torbic 6 , Sudhir Krishnan 1 , Abhijit Duggal 1



    AffiliationsFree PMC article Abstract

    Background: Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable. Objective: To investigate mortality rates due to ARDS from before the 2009 H1N1 influenza pandemic began until the start of coronavirus disease 2019 (COVID-19) pandemic. Design: We performed a systematic search and then ran a proportional meta-analysis for mortality. We ran our analysis in three ways: for randomised controlled trials only, for observational studies only, and for randomised controlled trials and observational studies combined. Data sources: MEDLINE and Embase, using a highly sensitive criterion and limiting the search to studies published from January 2009 to December 2019. Review methods: Two of us independently screened titles and abstracts to first identify studies and then complete full text reviews of selected studies. We assessed risk of bias using the Cochrane RoB-2 (a risk-of-bias tool for randomised trials) and the Cochrane ROBINS-1 (a risk-of-bias tool for non-randomised studies of interventions). Results: We screened 5844 citations, of which 102 fully met our inclusion criteria. These included 34 randomised controlled trials and 68 observational studies, with a total of 24 158 patients. The weighted pooled mortality rate for all 102 studies published from 2009 to 2019 was 39.4% (95% CI, 37.0-41.8%). Mortality was higher in observational studies compared with randomised controlled trials (41.8% [95% CI, 38.9-44.8%] v 34.5% [95% CI, 30.6-38.5%]; P = 0.005). Conclusions: Over the past decade, mortality rates due to ARDS were high. There is a clear distinction between mortality in observational studies and in randomised controlled trials. Future studies need to report mortality for different ARDS phenotypes and closely adhere to evidence-based medicine. PROSPERO registration: CRD42020149712 (April 2020).


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