Objectives
To provide a rapid overview of the evidence on the epidemiology, burden, and management of ARDS, including COVID-19.
Methods
We conducted a focused search of MEDLINE, Embase, heoro.com, clinicaltrials.gov and key HTA and regulatory sites for primary research, guidelines and HTA reports on the epidemiology, economic and humanistic burden, management, and unmet needs in ARDS. Titles and abstracts were screened and indexed to give priority to HTA and SLRs and larger more recent studies. Included studies were added to an Evidence Map and relevant data was summarised.
Results
The shortlist included 485 articles, of which 113 were ongoing trial protocols. We also included 13 guidelines, 19 HTA documents, 18 RCTs, and 17 narrative reviews. ARDS affects 1 to 10% of patients in ICU and mortality rates are 20 to 30%. Risk factors include trauma, pneumonia, and sepsis. No intervention has been shown to significantly reduce mortality, and improvement in overall rates of mechanical ventilation were minimal. Survivors and caregivers have impaired quality of life. 30 to 40% of survivors, and 30% of caregivers, suffer with neuropsychiatric problems, and fewer than 50% of survivors have returned to work 12 months post-discharge. Other unmet needs include diagnosis issues, poor communication of prognosis and a lack of discussion of patient preferences. One third of ongoing trials and articles published in the last year were related to COVID-19, with interventions assessed including angiotensin II receptor blockers, stem cells, corticosteroids, and hydroxychloroquine.
Conclusions
The review highlighted the long-term burden of survivors, in terms of employment issues, psychological well-being, PTSD, as well as the negative impact on caregivers. The review also highlighted patient subgroups with differences in symptom severity, prognosis, and subsequent cost implications. The Evidence Map allows a rapid investigation of the area and, by highlighting gaps, could help guide and inform future research.