Background: Pulmonary complications following injury significantly contribute to subsequent mortality. Obese patients have preexisting risk factors for pulmonary complications, and are at risk for these complications following elective surgery. Whether or not obesity contributes to pulmonary complications after critical injury is poorly understood.

High-quality data on cuff dehiscence after hysterectomy are limited. Potentially modifiable risks that optimize vaginal wound healing, minimize vaginal cuff strain, and minimize cuff infection should be optimized.

Objective The acute respiratory distress syndrome (ARDS) is a pro-inflammatory condition that often complicates trauma and critical illness. Animal studies have shown that both gender and sex hormones play an important role in inflammatory regulation. Human data is scant regarding the role of gender and sex hormones in developing ARDS. Our objective was to describe gender and hormonal differences in patients who develop ARDS in a large cohort of critically injured adults. Methods A prospective cohort study of adult trauma patients requiring ICU admission for at least 48 hours was performed. Demographic and clinical data was collected prospectively, and sex hormones were assayed at study entry (48 hours). The primary outcome was the development of ARDS. Multivariate logistic regression was used to determine the adjusted odds of death associated with differences in gender. Results 648 patients met entry criteria and 180 patients developed ARDS (31%). Females were more likely to develop ARDS (35 % versus 25%, p=0.02). This association remained after adjusting for age, mechanism of injury, injury severity and blood product transfusion (OR 1.6 95% CI 1.1 – 2.4, p=0.02). Of patients with ARDS, there was no difference in mortality related to gender (22% mortality in females with ARDS versus 20% in males, p=NS). A pro-inflammatory sex hormone profile (low testosterone, high estradiol) was associated with ARDS in both males and females. Conclusion Females are more likely than males to develop ARDS following critical injury. Despite the increased incidence in ARDS, the mortality in patients with ARDS does not differ according to gender. The inflammatory properties of sex hormones may contribute to ARDS, but they do not fully explain observed gender differences.