Tran Alexandre, Fernando Shannon M, Brochard Laurent J, Fan Eddy, Inaba Kenji, Ferguson Niall D, Calfee Carolyn S, Burns Karen E A, Brodie Daniel, McCredie Victoria A, Kim Dennis Y, Kyeremanteng Kwadwo, Lampron Jacinthe, Slutsky Arthur S, Combes Alain, Rochwerg Bram
Dept of Surgery, University of Ottawa, Ottawa, ON, Canada
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Eur Respir J. 2022 Apr 14;59(4). doi: 10.1183/13993003.00857-2021. Print 2022 Apr.
Our purpose was to summarise the prognostic associations between various clinical risk factors and development of acute respiratory distress syndrome (ARDS) following traumatic injury.
We conducted this review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) guidelines. We searched six databases from inception through December 2020. We included English language studies describing the clinical risk factors associated with development of post-traumatic ARDS, as defined by either the American-European Consensus Conference or Berlin definition. We pooled adjusted odds ratios for prognostic factors using the random effects method. We assessed risk of bias using the QUIPS (Quality in Prognosis Studies) tool and certainty of findings using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.
We included 39 studies involving 5 350 927 patients. We identified the amount of crystalloid resuscitation as a potentially modifiable prognostic factor associated with development of post-traumatic ARDS (adjusted OR 1.19, 95% CI 1.15-1.24 for each additional litre of crystalloid administered within the first 6 h after injury; high certainty). Non-modifiable prognostic factors with a moderate or high certainty of association with post-traumatic ARDS included increasing age, non-Hispanic White race, blunt mechanism of injury, presence of head injury, pulmonary contusion or rib fracture and increasing chest injury severity.
We identified one important modifiable factor, the amount of crystalloid resuscitation within the first 24 h of injury, and several non-modifiable factors associated with development of post-traumatic ARDS. This information should support the judicious use of crystalloid resuscitation in trauma patients and may inform development of risk stratification tools.
我们的目的是总结各种临床风险因素与创伤后急性呼吸窘迫综合征（ARDS）发生之间的预后关联。
我们按照PRISMA（系统评价和Meta分析的首选报告项目）和CHARMS（预测模型研究系统评价的关键评估和数据提取）指南进行了这项综述。我们检索了从建库至2020年12月的六个数据库。我们纳入了描述与创伤后ARDS发生相关的临床风险因素的英文研究，创伤后ARDS的定义依据美国-欧洲共识会议或柏林定义。我们使用随机效应方法汇总了预后因素的调整比值比。我们使用QUIPS（预后研究质量）工具评估偏倚风险，并使用GRADE（推荐分级评估、制定和评价）方法评估研究结果的确定性。
我们纳入了39项研究，涉及5350927例患者。我们确定晶体液复苏量是与创伤后ARDS发生相关的一个潜在可改变的预后因素（伤后6小时内每额外输注1升晶体液，调整后的OR为1.19，95%CI为1.15-1.24；高确定性）。与创伤后ARDS发生有中度或高度关联确定性的不可改变的预后因素包括年龄增加、非西班牙裔白人种族、钝性损伤机制、存在头部损伤、肺挫伤或肋骨骨折以及胸部损伤严重程度增加。
我们确定了一个重要的可改变因素，即伤后24小时内的晶体液复苏量，以及几个与创伤后ARDS发生相关的不可改变因素。这些信息应有助于在创伤患者中明智地使用晶体液复苏，并可能为风险分层工具的开发提供参考。
