Between-trial heterogeneity in ARDS research

Between-trial heterogeneity in ARDS research

Purpose Most randomized controlled trials (RCTs) in patients with acute respiratory distress syndrome (ARDS) revealed indeterminate or conflicting study results. We aimed to systematically evaluate between-trial heterogeneity in reporting standards and trial outcome. Methods A systematic review of R...

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Bibliographic Details
Published in:Intensive care medicine Vol. 47; no. 4; pp. 422 - 434
Main Authors: Juschten, J., Tuinman, P. R., Guo, T., Juffermans, N. P., Schultz, M. J., Loer, S. A., Girbes, A. R. J., de Grooth, H. J.
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2021
Springer
Springer Nature B.V
Subjects:
Acute respiratory distress syndrome
Analysis
Anesthesiology
Blood pressure
Canada
Clinical trials
Critical Care Medicine
Emergency Medicine
Health aspects
Heterogeneity
Intensive
Intensive care
Lungs
Mechanical ventilation
Medicine
Medicine & Public Health
Mortality
Netherlands
Pain Medicine
Pediatrics
Pneumology/Respiratory System
Regression models
Systematic Review
United Kingdom
Variability
Ventilation
Canada
United Kingdom
Netherlands
Critical Care Research
Heterogeneity
ARDS
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Summary:Purpose Most randomized controlled trials (RCTs) in patients with acute respiratory distress syndrome (ARDS) revealed indeterminate or conflicting study results. We aimed to systematically evaluate between-trial heterogeneity in reporting standards and trial outcome. Methods A systematic review of RCTs published between 2000 and 2019 was performed including adult ARDS patients receiving lung-protective ventilation. A random-effects meta-regression model was applied to quantify heterogeneity (non-random variability) and to evaluate trial and patient characteristics as sources of heterogeneity. Results In total, 67 RCTs were included. The 28-day control-group mortality rate ranged from 10 to 67% with large non-random heterogeneity ( I 2  = 88%, p  < 0.0001). Reported baseline patient characteristics explained some of the outcome heterogeneity, but only six trials (9%) reported all four independently predictive variables (mean age, mean lung injury score, mean plateau pressure and mean arterial pH). The 28-day control group mortality adjusted for patient characteristics (i.e. the residual heterogeneity) ranged from 18 to 45%. Trials with significant benefit in the primary outcome reported a higher control group mortality than trials with an indeterminate outcome or harm (mean 28-day control group mortality: 44% vs. 28%; p  = 0.001). Conclusion Among ARDS RCTs in the lung-protective ventilation era, there was large variability in the description of baseline characteristics and significant unexplainable heterogeneity in 28-day control group mortality. These findings signify problems with the generalizability of ARDS research and underline the urgent need for standardized reporting of trial and baseline characteristics.
Bibliography:content type line 23
SourceType-Scholarly Journals-1
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-021-06370-w