Mortality risk of hypoxaemic acute respiratory failure among Indonesians: A systematic review and meta-analysis

Abstract Background Hypoxaemic acute respiratory failure (ARF) is a life-threatening condition with high global mortality, especially in low- and middle-income countries. In Indonesia, where healthcare access and oxygen infrastructure are unevenly distributed, the mortality burden of hypoxaemic ARF remains poorly quantified. Objectives This systematic review and meta-analysis aims to evaluate the mortality risk of hypoxaemic ARF in the Indonesian population across all age groups. Methods A systematic search was conducted across MEDLINE, Embase, CENTRAL, Scopus, and manual searches in Garuda and Google Scholar (as of 24 July 2023). Eligible studies included those reporting mortality outcomes among patients with hypoxaemic ARF in Indonesia. The Joanna Briggs Institute checklist for prevalence studies was used for quality assessment. Data were analysed using R-4.3.1 with random-effects meta-analysis, and subgroup analyses were performed based on the pandemic period. The protocol is registered with PROSPERO, CRD42023451225. Results and discussion Of 9763 screened records, 8 studies met the inclusion criteria, comprising data from 757 patients. The pooled mortality risk of hypoxaemic ARF was 41% (95% CI: 32–50), with higher mortality during the pre-pandemic era (47%) compared to the pandemic era (24%). The findings are in line with global estimates and reinforce the critical need to strengthen oxygen availability, monitoring and delivery systems in Indonesia. Conclusion Hypoxaemic ARF remains a major contributor to in-hospital mortality in Indonesia, particularly where oxygen access is limited. Strengthening oxygen security and investing in early hypoxaemia detection are essential steps to reduce mortality in future respiratory emergencies.