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- Title
Between-trial heterogeneity in ARDS research.
- 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.
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>In total, 67 RCTs were included. The 28-day control-group mortality rate ranged from 10 to 67% with large non-random heterogeneity (I2 = 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).<bold>Conclusion: </bold>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.
- Subjects
ADULT respiratory distress syndrome; HETEROGENEITY
- Publication
Intensive Care Medicine, 2021, Vol 47, Issue 4, p422
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-021-06370-w