The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

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Abstract

Background

Previous studies have found various incidences of right ventricular (RV) injury and its association with clinical outcome in patients with acute respiratory distress syndrome (ARDS). In this systematic review and meta-analysis, we aimed to investigate the impact of the presence of RV injury on mortality in patients with ARDS.

Method

We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies investigating the association between RV injury and mortality. Two authors independently evaluated whether studies meet eligibility criteria and extracted the selected patients and studies characteristics and outcomes. RV injury was diagnosed by trans-thoracic echocardiogram (TTE), trans-esophageal echocardiogram (TEE) and PAC (pulmonary artery catheter) in the included studies. The primary outcome was the association between mortality and the presence of RV injury in patients with ARDS. The overall reported mortality was defined as either the intensive care unit (ICU) mortality, in-hospital mortality, or mortality within 90days, and short-term mortality was defined as ICU-mortality, in-hospital mortality, or mortality within 30days.

Results

We included 9 studies ( N=1861 patients) in this meta-analysis. RV injury that included RV dysfunction, RV dysfunction with hemodynamic compromise, RV failure, or acute cor-pulmonale was present in 21.0% (391/1,861). In the pooled meta-analysis, the presence of RV injury in patients with ARDS was associated with significantly higher overall mortality (OR 1.45, 95% CI 1.131.86, p-value=0.003, I ²=0%), as well as short-term mortality (OR 1.48, 95% CI 1.141.93, p-value=0.003, I ²=0%).

Conclusion

In this systematic review and meta-analysis including 1861 patients with ARDS, the presence of RV injury was significantly associated with increased overall and short-term mortality.

Trial registration: The protocol was registered at PROSPERO (CRD42020206521).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-021-03591-9.

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Most cited references 41

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Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

David Moher, Larissa Shamseer, Mike Clarke … (2017)

Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.

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Andreas Stang (2010)

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Author and article information

Contributors

Siddharth Dugar:

ORCID: http://orcid.org/0000-0002-3243-1417

dugars@ccf.org

Journal

Journal ID (nlm-ta): Crit Care

Title: Critical Care

Publisher: BioMed Central (London )

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Electronic): 21 May 2021

Publication date PMC-release: 21 May 2021

Publication date Collection: 2021

Volume: 25

Electronic Location Identifier: 172

Affiliations

[1 ]GRID grid.239578.2, ISNI 0000 0001 0675 4725, Department of Critical Care Medicine, Respiratory Institute, , Cleveland Clinic, ; 9500 Euclid Avenue, Cleveland, OH USA

[2 ]GRID grid.67105.35, ISNI 0000 0001 2164 3847, Cleveland Clinic Lerner College of Medicine, , Case Western University Reserve University, ; Cleveland, OH USA

[3 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Division of Nephrology and Hypertension, Department of Medicine, , Mayo Clinic, ; Rochester, MN USA

[4 ]GRID grid.239578.2, ISNI 0000 0001 0675 4725, The Cleveland Clinic Floyd D. Loop Alumni Library, , Cleveland Clinic, ; Cleveland, OH USA

[5 ]GRID grid.239578.2, ISNI 0000 0001 0675 4725, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, , Cleveland Clinic, ; Cleveland, OH USA

[6 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Department of Cardiovascular Medicine, , Mayo Clinic, ; Rochester, MN USA

[7 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Division of Pulmonary and Critical Care Medicine, Department of Medicine, , Mayo Clinic, ; Rochester, MN USA

[8 ]GRID grid.66875.3a, ISNI 0000 0004 0459 167X, Center for Clinical and Translational Science, , Mayo Clinic Graduate School of Biomedical Sciences, ; Rochester, MN USA

[9 ]GRID grid.189967.8, ISNI 0000 0001 0941 6502, Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, , Emory University of School of Medicine, ; Atlanta, GA USA

Author information

Siddharth Dugar http://orcid.org/0000-0002-3243-1417

Article

Publisher ID: 3591

DOI: 10.1186/s13054-021-03591-9

PMC ID: 8138512

PubMed ID: 34020703

SO-VID: ce510a74-289f-4e0a-ac3e-2ef119f71705

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 1 March 2021

Date accepted : 29 April 2021

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: right ventricular dysfunction,acute cor pulmonale,acute respiratory distress syndrome,acute lung injury

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: right ventricular dysfunction, acute cor pulmonale, acute respiratory distress syndrome, acute lung injury

The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

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Abstract

Background

Method

Results

Conclusion

Supplementary Information

Related collections

Irish Journal of Paramedicine

Most cited references 41

Measuring inconsistency in meta-analyses.

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.

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