J Neurocrit Care.  2022 Jun;15(1):12-20. 10.18700/jnc.220043.

Prevalence and outcomes of acute respiratory distress syndrome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

• Fan TH
• Huang M
• Price C
• Premraj L
• Kannapadi NV
• Suarez JI
• Cho SM

• KMID: 2531995
• DOI: http://doi.org/10.18700/jnc.220043

Abstract

Background
In this study, we aimed to investigate the prevalence, timing, risk factors, and outcomes of acute respiratory distress syndrome (ARDS) in patients with aneurysmal subarachnoid hemorrhage (aSAH).
Methods
PubMed and four other databases were searched for randomized controlled trials (RCTs) and observational studies of patients 18 years or older through October 20, 2021. Study quality was assessed, using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for cohort and case-control studies. High-grade aSAH was defined as a Hunt-Hess grade≥3 and/or a modified Fisher score≥3. A good neurological outcome was defined as a Glasgow Outcome Scale score ≥4. Random-effects meta-analyses were conducted to estimate the pooled outcome prevalence and 95% confidence interval (CI).
Results
Eleven observational studies (n=6,107) met the inclusion criteria. Overall, 15% of the patients (95% CI=10.5–20.0; I2=97.8%) developed ARDS after aSAH, with a mean time of 3 days (95% CI=1.9–3.7; I2=54%). Overall survival at discharge was 80% (95% CI=75–86; I2=96%), and 67% of aSAH patients (95% CI=54.9–78.9; I2=94%) had a good neurological outcome at any time. The aSAH cohort without ARDS had a higher rate of survival than those with ARDS (79% vs. 49%, P=0.028). Male sex, patients with a high-grade aSAH, patients who developed pneumonia, and systemic inflammatory response syndrome during hospital admission were at a higher risk of developing ARDS.
Conclusion
In this meta-analysis, approximately one in six patients developed ARDS after aSAH, with a mean time of 3 days from the initial presentation, and ARDS was associated with increased mortality.

Keyword

Acute respiratory distress syndrome; Subarachnoid hemorrhage; Intracranial hemorrhage; Acute brain injury; Neurogenic pulmonary edema; Acute lung injury

Figure

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  Fig. 1. Study flowchart for the literature search and selection of studies. ARDS, acute respiratory distress stress; aSAH, aneurysmal subarachnoid hemorrhage.

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  Fig. 2. Meta-analysis of the prevalence of acute respiratory distress stress among patients with aneurysmal subarachnoid hemorrhage. I2 quantifies the degree of heterogeneity across the studies, and ranges from 0% to 100%. CI, confidence interval.

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  Fig. 3. Meta-analysis of the time in days from diagnosis of aneurysmal subarachnoid hemorrhage to the onset of acute respiratory distress stress (ARDS). I2 quantifies the degree of heterogeneity across the studies, and ranges from 0% to 100%. CI, confidence interval.

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  Fig. 4. Meta-analysis of overall survival at discharge in patients with aneurysmal subarachnoid hemorrhage. I2 quantifies the degree of heterogeneity across the studies, and ranges from 0% to 100%. CI, confidence interval.

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  Fig. 5. Meta-analysis of overall good neurological outcomes at any time in patients with aneurysmal subarachnoid hemorrhage. I2 quantifies the degree of heterogeneity across the studies, and ranges from 0% to 100%. CI, confidence interval.

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