Abstract
Rationale We wished to determine the influence of sex on the management and outcomes in acute respiratory distress syndrome (ARDS) patients in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE).
Methods We assessed the effect of sex on mortality, intensive care unit and hospital length of stay, and duration of invasive mechanical ventilation (IMV) in patients with ARDS who underwent IMV, adjusting for plausible clinical and geographic confounders.
Findings Of 2377 patients with ARDS, 905 (38%) were female and 1472 (62%) were male. There were no sex differences in clinician recognition of ARDS or critical illness severity profile. Females received higher tidal volumes (8.2±2.1 versus 7.2±1.6 mL·kg−1; p<0.0001) and higher plateau and driving pressures compared with males. Lower tidal volume ventilation was received by 50% of females compared with 74% of males (p<0.0001). In shorter patients (height ≤1.69 m), females were significantly less likely to receive lower tidal volumes. Surviving females had a shorter duration of IMV and reduced length of stay compared with males. Overall hospital mortality was similar in females (40.2%) versus males (40.2%). However, female sex was associated with higher mortality in patients with severe confirmed ARDS (OR for sex (male versus female) 0.35, 95% CI 0.14–0.83).
Conclusions Shorter females with ARDS are less likely to receive lower tidal volume ventilation, while females with severe confirmed ARDS have a higher mortality risk. These data highlight the need for better ventilatory management in females to improve their outcomes from ARDS.
Abstract
Shorter females with ARDS were less likely to receive lower tidal volume ventilation than shorter males, while mortality rates were higher in females with confirmed severe ARDS. Better ventilatory management may improve outcomes in females with ARDS. http://bit.ly/2JIsUBz
Footnotes
This article has supplementary material available from erj.ersjournals.com
Support statement: This work was funded and supported by the European Society of Intensive Care Medicine (ESICM; Brussels, Belgium), by St Michael's Hospital (Toronto, ON, Canada) and by the University of Milan-Bicocca (Monza, Italy). These funders had no role in the design and conduct of the study; management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication. Funding information for this article has been deposited with the Crossref Funder Registry.
Author contributions: Study concept and design: J.G. Laffey, G. Bellani, T. Pham and L. Brochard; acquisition of data: J.G. Laffey, G. Bellani, T. Pham and L. Brochard; analysis and interpretation of data: B.A. McNicholas, F. Madotto, E. Rezoagli, T. Pham, C.H. Masterson, S. Horie and J.G. Laffey; drafting of the manuscript: all authors; critical revision of the manuscript for important intellectual content: all authors; statistical analysis: F. Madotto, T. Pham and E. Rezoagli; obtained funding: G. Bellani and J.G. Laffey; study supervision: J.G. Laffey, G. Bellani and L. Brochard; approved the final draft of the manuscript: all authors.
Conflict of interest: B.A. McNicholas has nothing to disclose.
Conflict of interest: F. Madotto has nothing to disclose.
Conflict of interest: T. Pham has nothing to disclose.
Conflict of interest: E. Rezoagli has nothing to disclose.
Conflict of interest: C.H. Masterson has nothing to disclose.
Conflict of interest: S. Horie has nothing to disclose.
Conflict of interest: G. Bellani reports grants and personal fees from Draeger Medical, personal fees from Hamilton, Getinge and Dimar SRL, outside the submitted work.
Conflict of interest: L. Brochard reports grants from Covidien, grants and nonfinancial support from Fisher Paykel, Air Liquide and General Electric, nonfinancial support from Philips and Sentec, outside the submitted work.
Conflict of interest: J.G. Laffey has nothing to disclose.
- Received March 26, 2019.
- Accepted July 4, 2019.
- Copyright ©ERS 2019
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