Respiratory failure & ventilation
Complications in acute respiratory distress syndrome: a systematic review and meta-analysis
Authors' conclusion
In this systematic review of studies including patients with ARDS receiving IMV, reporting of complications was variable and infrequent.
Study context
- Population
- Adults with acute respiratory distress syndrome (ARDS) undergoing invasive mechanical ventilation (IMV); COVID-19, ≥25% on extracorporeal life support and <200 participants excluded53 studies (25 RCTs, 28 cohort)
- Outcome
- Complications (any reported clinical complication, author definitions)
Methodological detailsrandom effects meta-analysis, logit-transformed proportions, inverse-variance weighting, Searched to November 28, 2025; 25,421 citations, 2620 full texts reviewed
- Random effects meta-analysis
- Logit-transformed proportions
- Inverse-variance weighting
- Searched to November 28, 2025; 25,421 citations, 2620 full texts reviewed
Pooled result
As reported in the abstract
Reporting of complications
- Complications variably and infrequently reported
- Only barotrauma, ventilator associated pneumonia (VAP), hypotension, arrhythmia, stroke, myopathy and cardiac arrest reported by ≥3 RCTs
- In cohort studies, barotrauma, VAP, acute renal failure, sepsis and bacteremia reported by ≥3 studies
- All estimates featured considerable heterogeneity
- Descriptive synthesis; causality not investigated
Original publication
Complications in acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care. Published 29 March 2026. doi:10.
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