RT Journal Article
SR Electronic
T1 Demographics, management and outcome of women and men with Acute Respiratory Distress Syndrome in the LUNG SAFE prospective cohort study
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1900609
DO 10.1183/13993003.00609-2019
A1 Bairbre A. McNicholas
A1 Fabiana Madotto
A1 Tài Pham
A1 Emanuele Rezoagli
A1 Claire H. Masterson
A1 Shahd Horie
A1 Giacomo Bellani
A1 Laurent Brochard
A1 John G. Laffey
A1 ,
YR 2019
UL http://erj.ersjournals.com/content/early/2019/07/08/13993003.00609-2019.abstract
AB 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, length of stay (LOS) 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 while 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 to males. Lower tidal volume ventilation was received by 50% of females compared to 74% of males p<0.0001). In shorter patients (≤1.69 m) females were significantly less likely to receive lower tidal volumes. Surviving females had a shorter duration of IMV and reduced LOS compared to 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 (odds ratio for sex (male versus female) 0.35, 95% confidence interval 0.14–0.83).Interpretation 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.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. McNicholas has nothing to disclose.Conflict of interest: Dr. Madotto has nothing to disclose.Conflict of interest: Dr. PHAM has nothing to disclose.Conflict of interest: Dr. Rezoagli has nothing to disclose.Conflict of interest: Dr. Masterson has nothing to disclose.Conflict of interest: Dr. Horie has nothing to disclose.Conflict of interest: Dr. Bellani reports grants and personal fees from Draeger Medical, personal fees from Hamilton, personal fees from Getinge, personal fees from Dimar SRL, outside the submitted work.Conflict of interest: Dr. Brochard reports grants from Covidien, grants and non-financial support from Fisher Paykel, grants and non-financial support from Air Liquide, non-financial support from Philips, non-financial support from Sentec, grants and non-financial support from General Electric, outside the submitted work.Conflict of interest: Dr. Laffey has nothing to disclose.