Incidence and Mortality of Acute Respiratory Distress Syndrome in Patients With Burns: A Systematic Review and Meta-Analysis

Abstract

Objective: We conducted a systematic review and meta-analysis to comprehensively estimate the incidence and mortality of acute respiratory distress syndrome (ARDS) in overall and subgroups of patients with burns.Data sources: Pubmed, Embase, the Cochrane Library, CINAHL databases, and China National Knowledge Infrastructure database were searched until September 1, 2021.Study selection: Articles that report study data on incidence or mortality of ARDS in patients with burns were selected.Data extraction: Two researchers independently screened the literature, extracted data, and assessed the quality. We performed a meta-analysis of the incidence and mortality of ARDS in patients with burns using a random effects model, which made subgroup analysis according to the study type, inclusion (mechanical ventilation, minimal burn surface), definitions of ARDS, geographic location, mean age, burn severity, and inhalation injury. Primary outcomes were the incidence and mortality of burns patients with ARDS, and secondary outcomes were incidence for different subgroups.Data synthesis: Pooled weighted estimate of the incidence and mortality of ARDS in patients with burns was 0.24 [95% confidence interval (CI)0.2–0.28] and 0.31 [95% CI 0.18−0.44]. Incidences of ARDS were obviously higher in patients on mechanical ventilation (incidence = 0.37), diagnosed by Berlin definition (incidence = 0.35), and with over 50% inhalation injury proportion (incidence = 0.41) than in overall patients with burns. Patients with burns who came from western countries and with inhalation injury have a significantly higher incidence of ARDS compared with those who came from Asian/African countries (0.28 vs. 0.25) and without inhalation injury (0.41 vs. 0.24).Conclusion: This systematic review and meta-analysis revealed that the incidence of ARDS in patients with burns is 24% and that mortality is as high as 31%. The incidence rates are related to mechanical ventilation, location, and inhalation injury. The patients with burns from western countries and with inhalation injury have a significantly higher incidence than patients from Asian/African countries and without inhalation injury.Systematic Review Registration: identifier: CRD42021144888.

Efficacy and safety of extracorporeal membrane oxygenation for burn patients: a comprehensive systematic review and meta-analysis

“…For total intensive care unit patients with ARDS, the mortality of moderate ARDS and severe ARDS was 40.3% and 46.1%, respectively [ 42 ]. A recent systematic review found that the overall mortality of burn patients with ARDS was 27% [ 5 ]. As for the different subgroups of ARDS, the reported mortality of moderate ARDS was 36.1% [ 43 ] and 20.9% [ 44 ], and the mortality of severe ARDS was 43.8% [ 43 ] and 50% [ 44 ] in different studies.…”

“…A survey of 6212 burn deaths showed that burn shock, cardiogenic shock or lung injury, and sepsis or multiple organ failure were the main causes of death within the first week, weeks 1 to 2, and after 2 weeks, respectively [ 2 ]. The incidence of burn-induced acute respiratory distress syndrome (ARDS) is reported to be 2–53% and mortality is 14–68% [ 5 ]. Cardiac stress, characterized with tachycardia, systolic dysfunction, increased cardiac output and energy expenditure, is the hallmark of severe burns and persists for up to 3 years after burns [ 6 ].…”

Combat Trauma-Related Acute Respiratory Distress Syndrome: A Scoping Review

“…They also found that explosion injury did not independently increase the risk of ARDS, despite pulmonary contusion being a known risk factor for ARDS (20). The other nonmodifiable risk factors including pulmonary injury (14), blunt trauma (16), and II (14) could be causative as indicated by civilian literature (11, 46), whereas higher MISS (20) and higher ISS (5) may be more indicative of severe injury, though more studies are needed to investigate causation.…”

“…Trauma is a well-defined etiology of ARDS, and there have been a number of studies summarizing its literature and characterizing it in the civilian trauma population (5)(6)(7)(8)(9)(10)(11). However, data specific to combat trauma-related ARDS are lacking.…”

A heterogenous population of extracellular vesicles mobilize to the alveoli postinjury

“…Severe trauma and burn injury cause a systemic inflammatory response syndrome (SIRS) that can result in acute lung injury (ALI) and cause prolonged intensive care unit stays, complications, and death 1 . Acute lung injury and acute respiratory distress syndrome (ARDS) remain significant clinical problems for patients who experience severe injury, with mortality rates approaching 31% 2 . Dysregulation of the immune system as part of SIRS is a principal driver of lung inflammation 3 .…”