The following is a summary of “Smoking on the risk of acute respiratory distress syndrome: a systematic review and meta-analysis,” published in the April 2024 issue of Critical Care by Zhang et al.

Despite recognition of a link between smoking and acute respiratory distress syndrome (ARDS), findings on this connection have been contradictory.

Researchers conducted a retrospective study examining the link between smoking and ARDS risk in adults through a systematic review and meta-analysis.

They searched PubMed, EMBASE, Cochrane Library, and Web of Science databases for studies published (January 1, 2000, and December 31, 2023). Adult patients with clinical risk factors for ARDS and a smoking history were included. Outcomes were measured using ORs for binary variables, MDs for continuous variables, and a standard 95% CI.

The results showed 26 observational studies with 36,995 patients. Smoking was significantly associated with an increased risk of ARDS (OR 1.67; 95% CI 1.33–2.08; P<0.001). Patient-reported smoking history had similar associations with ARDS (OR 1.78; 95% CI 1.38–2.28; P<0.001). Tobacco metabolite detection showed no significant difference in ARDS risk (OR 1.19; 95% CI 0.69–2.05; P=0.53). The 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is a metabolite of tobacco products. The smoking group was younger than the control group (MD − 7.15; 95% CI −11.58 to −2.72; P=0.002). Smoking notably increased ARDS incidence with extrapulmonary etiologies (OR 1.85; 95% CI 1.43–2.38; P<0.001). Publication bias did not affect our conclusions’ integrity. Sensitivity analysis reinforced our aggregated outcomes’ reliability.

Investigators found a strong correlation between smoking and increased ARDS risk, underlining the importance of comprehensive smoking history evaluation and close monitoring of smokers, particularly those with additional non-lung risk factors for ARDS.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04902-6