Department of Trauma, UniversitätsSpital Zürich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
World J Surg. 2020 Jul;44(7):2243-2254. doi: 10.1007/s00268-020-05483-5.
Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. In addition, its aetiologies are heterogeneous, and the outcome depends on the underlying cause. In trauma care, changes in diagnostics, management and treatment may influence the outcome of posttraumatic ARDS over time, which are attributable to geographic distribution, relate to the definition used and depend on the injury severity.
We selected studies by searching PubMed using the MeSH terms "acute respiratory distress syndrome", "mortality" and "trauma" and all their combinations. Studies that reported mortality rates for polytrauma patients with ARDS were included. We excluded studies with selected population collectives (e.g. burn patients, isolated thoracic trauma and paediatric trauma) and non-trauma studies. Studies were stratified according to the recruitment year of patients into Decade 1 (prior 1990), Decade 2(1990-1999), Decade 3 (2000-2009) and Decade 4 (later 2009); geographic location (North America or Europe), the definition used in the different studies (American European Consensus Conference (AECC) definition or Berlin definition) and the mean injury severity of the patient populations, respectively.
Twenty-three studies between 1 January 1980 and 30 June 2018 were included in the analysis (486,861 patients, 52,561 with posttraumatic ARDS). There was a wide variation in mortality rates among the studies (4-39%). The overall pooled mean mortality rate for all studies was 21.8%, SD ± 8.3%. The mean mortality over the last four decades was similar between decade 1 (25.8%), decade 2 (20.6%), decade 3 (20.7%) and decade 4 (22.5%). Geographical observations comparing Europe and North America revealed no difference [Europe (22.1%) and North America (21.7%)]. The ARDS mortality in publications using the Berlin definition (23%) was comparable to the mortality rate in publications using the AECC definition (22.9%). The mortality rate based on the injury severity showed no alteration (ISS ≤ 25 points, 22.6%, ISS > 25 points, 22.6%).
In this systematic review, there was no change in the mortality rate over the last four decades, no geographical difference within Western societies, no dependence on the ARDS definition used and no association with injury severity, respectively.
急性呼吸窘迫综合征（ARDS）发病率和死亡率均较高。此外，其病因具有异质性，其预后取决于基础病因。在创伤救治中，诊断、治疗和管理方法的变化可能会随时间推移而影响创伤后 ARDS 的结局，这归因于地域分布、所使用的定义以及损伤严重程度。
我们通过在 PubMed 中使用 MeSH 术语“急性呼吸窘迫综合征”、“死亡率”和“创伤”及其所有组合进行搜索来选择研究。纳入报告了 ARDS 多发伤患者死亡率的研究。我们排除了具有特定人群集合的研究（例如烧伤患者、单纯性胸部创伤和儿科创伤）和非创伤研究。根据患者入组年份将研究分层为 4 个十年期：第一个十年期（1990 年前）、第二个十年期（1990-1999 年）、第三个十年期（2000-2009 年）和第四个十年期（2009 年后）；地理区域（北美或欧洲）、不同研究中使用的定义（美国-欧洲共识会议（AECC）定义或柏林定义）以及患者人群的平均损伤严重程度。
1980 年 1 月 1 日至 2018 年 6 月 30 日期间共纳入 23 项研究（涉及 486861 名患者，其中 52561 名为创伤后 ARDS 患者）。这些研究之间的死亡率差异很大（4%-39%）。所有研究的总体平均死亡率为 21.8%，标准差±8.3%。过去 40 年来，第 1 个十年（25.8%）、第 2 个十年（20.6%）、第 3 个十年（20.7%）和第 4 个十年（22.5%）的平均死亡率相似。比较欧洲和北美的地理观察结果表明，两者之间没有差异[欧洲（22.1%）和北美（21.7%）]。使用柏林定义的 ARDS 死亡率（23%）与使用 AECC 定义的死亡率（22.9%）相当。基于损伤严重程度的死亡率没有变化（ISS≤25 分，22.6%；ISS＞25 分，22.6%）。
在这项系统评价中，过去 40 年来死亡率没有变化，西半球内部没有地域差异，也与所使用的 ARDS 定义或损伤严重程度无关。
