Sex difference and intra-operative tidal volume

Nijbroek, Sunny G. L. H.; Hol, Liselotte; Swart, Pien; Hemmes, Sabrine N.T.; Neto, Ary Serpa; Binnekade, Jan M.; Hedenstierna, Göran; Jaber, Samir; Hiesmayr, Michael; Hollmann, Markus W.; Mills, Gary H.; Melo, Marcos F. Vidal; Putensen, Christian; Schmid, Werner; Severgnini, Paolo; Wrigge, Hermann; Abreu, Marcelo Gama de; Pelosi, Paolo; Schultz, Marcus J.

doi:10.1097/eja.0000000000001476

Cited by 10 publications

(6 citation statements)

References 32 publications

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“…The findings of the mediation analysis are in line with findings of the previous studies in patients in the ICU ( 16) and in the operating room (12). In contrary to previous findings, we see that differences are only partly explained by sex per se.…”

Section: Discussionsupporting

confidence: 90%

“…Differences between females and males with regard to the use of LTVV have been described in surgery patients during general anesthesia (7)(8)(9)(10)(11)(12) as well as critically ill patients in the ICU-and irrespective of the presence of ARDS (13)(14)(15)(16)44). It is uncertain if the sex difference in the use of LTVV also exists in patients with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19—Insights From the PRoVENT–COVID Study

et al. 2022

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The purpose of this study was to compare and understand differences in the use of low tidal volume ventilation (LTVV) between females and males with acute respiratory distress syndrome (ARDS) related to coronavirus disease 2019 (COVID-19). This is a post-hoc analysis of an observational study in invasively ventilated patients with ARDS related to COVID-19 in 22 ICUs in the Netherlands. The primary endpoint was the use of LTVV, defined as having received a median tidal volume (VT) ≤6 ml/kg predicted body weight (PBW) during controlled ventilation. A mediation analysis was used to investigate the impact of anthropometric factors, next to the impact of sex per se. The analysis included 934 patients, 251 females and 683 males. All the patients had ARDS, and there were no differences in ARDS severity between the sexes. On the first day of ventilation, females received ventilation with a higher median VT compared with males [6.8 (interquartile range (IQR) 6.0–7.6 vs. 6.3 (IQR 5.8–6.9) ml/kg PBW; p < 0.001]. Consequently, females received LTVV less often than males (23 vs. 34%; p = 0.003). The difference in the use of LTVV became smaller but persisted over the next days (27 vs. 36%; p = 0.046 at day 2 and 28 vs. 38%; p = 0.030 at day 3). The difference in the use LTVV was significantly mediated by sex per se [average direct effect of the female sex, 7.5% (95% CI, 1.7–13.3%); p = 0.011] and by differences in the body height [average causal mediation effect, −17.5% (−21.5 to −13.5%); p < 0.001], but not by the differences in actual body weight [average causal mediation effect, 0.2% (−0.8 to 1.2%); p = 0.715]. In conclusion, in this cohort of patients with ARDS related to COVID-19, females received LTVV less often than males in the first days of invasive ventilation. The difference in the use of LTVV was mainly driven by an anthropometric factor, namely, body height. Use of LTVV may improve by paying attention to correct titration of VT, which should be based on PBW, which is a function of body height.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19—Insights From the PRoVENT–COVID Study

et al. 2022

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“…The use of IBW to calculate lung-protective ventilation (LPV) starting tidal volumes ( V t ) for ventilation raises additional considerations. The findings reported in the LAS VEGAS re-analysis by Nijbroek et al 11 point clearly to a phenomenon of systematic overventilation of patients in general, and women in particular. The V t analysis in this study found clustering, and incremental adjustment around default values.…”

Section: The Use Of Ideal Body Weight To Calculate Tidal Volumementioning

confidence: 83%

“…The Oh et al 9 and Nijbroek et al 11 studies share a desire to ensure that patients receive care tailored to their specific needs in a real-world clinical setting. In our analyses, we find that BMI-based IBW estimation, although slightly more arithmetically complex, may be beneficial in both contexts.…”

Section: Discussionmentioning

confidence: 99%

Ideal body weight calculations: fit for purpose in modern anaesthesia?

Appelbaum

Clarke

2021

European Journal of Anaesthesiology

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“…De Silva and coworkers evidenced that pacemakers, cardioverter defibrillators, and resynchronization therapy are less used in women than in men, independent of age or comorbidities [95]. In addition, women receive less invasive mechanical ventilation in comparison to men [96], as observed during general anesthesia [97] in critically ill patients [98,99], as well as less dialysis [100]. Furthermore, a German study highlighted that the prevalence of the continuous use of blood glucose monitors depends on age, sex, and gender [101].…”

Section: Access To Mdsmentioning

confidence: 99%

The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender

Campesi,

Franconi,

Serra

2024

Life

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Until now, research has been performed mainly in men, with a low recruitment of women; consequentially, biological, physiological, and physio-pathological mechanisms are less understood in women. Obviously, without data obtained on women, it is impossible to apply the results of research appropriately to women. This issue also applies to medical devices (MDs), and numerous problems linked to scarce pre-market research and clinical trials on MDs were evidenced after their introduction to the market. Globally, some MDs are less efficient in women than in men and sometimes MDs are less safe for women than men, although recently there has been a small but significant decrease in the sex and gender gap. As an example, cardiac resynchronization defibrillators seem to produce more beneficial effects in women than in men. It is also important to remember that MDs can impact the health of healthcare providers and this could occur in a sex- and gender-dependent manner. Recently, MDs’ complexity is rising, and to ensure their appropriate use they must have a sex–gender-sensitive approach. Unfortunately, the majority of physicians, healthcare providers, and developers of MDs still believe that the human population is only constituted by men. Therefore, to overcome the gender gap, a real collaboration between the inventors of MDs, health researchers, and health providers should be established to test MDs in female and male tissues, animals, and women.

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Sex difference and intra-operative tidal volume

Cited by 10 publications

References 32 publications

Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19—Insights From the PRoVENT–COVID Study

Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19—Insights From the PRoVENT–COVID Study

Ideal body weight calculations: fit for purpose in modern anaesthesia?

The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender

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