Academic Journal
Sex-Specific Differences in Tidal Volumes and Mortality of Mechanically Ventilated Patients.
| Τίτλος: | Sex-Specific Differences in Tidal Volumes and Mortality of Mechanically Ventilated Patients. |
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| Συγγραφείς: | Urner M; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., Rojas-Saunero LP; Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA., Buyck K; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada., Douflé G; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada., Amaral AC; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada., Adhikari NKJ; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada., Jüni P; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom., Hansen B; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.; Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, the Netherlands., Ferguson ND; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada.; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.; Department of Physiology, University of Toronto, Toronto, ON, Canada.; Division of Respirology, Department of Medicine, University Health Network, Toronto, ON, Canada., Fan E; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada.; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom., Mehta S; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada.; Department of Medicine, Sinai Health System, Toronto, ON, Canada. |
| Πηγή: | Critical care medicine [Crit Care Med] 2026 Aug 01; Vol. 54 (8), pp. 2124-2134. Date of Electronic Publication: 2026 Mar 31. |
| Τύπος έκδοσης: | Journal Article; Observational Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0355501 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0293 (Electronic) Linking ISSN: 00903493 NLM ISO Abbreviation: Crit Care Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: Philadelphia, PA : Lippincott Williams & Wilkins Original Publication: New York, Kolen. |
| Ιατρικοί όροι (MeSH): | Respiration, Artificial*/mortality , Tidal Volume*/physiology , Critical Illness*/mortality , Hospital Mortality*, Intensive Care Units/statistics & numerical data ; Ontario/epidemiology ; Humans ; Female ; Male ; Middle Aged ; Sex Factors ; Aged ; Registries ; Adult ; Cohort Studies ; Bayes Theorem |
| Περίληψη: | Objectives: Previous work reported that critically ill female patients received higher tidal volumes per predicted body weight (PBW) than male patients during the first 24 hours of mechanical ventilation, which might be associated with higher mortality. We investigated if sex inequity in daily tidal volumes during mechanical ventilation persisted beyond the first 24 hours and remained associated with mortality. Also, we examined if the association was mainly explained by baseline factors that differed between female and male patients. Design: In this registry-based cohort study, Bayesian joint models were used to estimate indirect (through tidal volumes) and direct effects of sex on mortality using data recorded in the Toronto Intensive Care Observational Registry between April 2014 and December 2022. Patients: Adult patients (18 yr old or older), mechanically ventilated for greater than or equal to 24 hours. Setting: Nine ICUs from six University of Toronto-affiliated hospitals. Intervention: None. Measurements and Main Results: Of 20,351 eligible patients, 7,635 (38%) were female. Unadjusted mortality was 18% for female (1,384/7,635) and 17% for male (2,113/12,716) patients. We noticed that 2820 female (37%) and 4335 male patients (34%) underwent mechanical ventilation without recordings for body height. Every increase in daily tidal volumes (1 mL/kg PBW) was associated with higher mortality (hazard ratio: 1.10, 95% credible intervals [CrIs], 1.07-1.13), adjusted for severity of illness changing over time. Female patients had on average a lower height and consistently received higher daily tidal volumes (+0.6 mL/kg PBW, 95% CrI, +0.6 to +0.7 mL/kg PBW) and driving pressures (+1 cm H 2 O; 95% CI, 1-1 cm H 2 O) compared with male patients, suggesting an indirect effect of sex on mortality mediated by ventilator management. No direct effect of sex on mortality was observed. Conclusions: Measurement of height and daily adjustments of tidal volumes and driving pressures may reduce mortality, particularly for female patients with lower height. (Copyright © 2026 by the Society of Critical Care Medicine and Wolters Kluwer Health, LLC. All Rights Reserved.) |
| Competing Interests: | Dr. Urner is supported by a Scholarship Award of the Interdepartmental Division of Critical Care Medicine of the University of Toronto. Dr. Fan is supported by a New Investigator Award from the Canadian Institutes of Health Research. Dr. Fan reports personal fees from Abbott, ALung Technologies, Fresenius Medical Care, and MC3 Cardiopulmonary outside the submitted work. Dr. Ferguson reports personal fees from Getinge, Baxter and Xenios, outside the submitted work. The remaining authors have disclosed that they do not have any potential conflicts of interest. |
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| Contributed Indexing: | Keywords: acute lung injury; inequity; intensive care unit; mechanical ventilation; tidal volumes |
| Entry Date(s): | Date Created: 20260331 Date Completed: 20260806 Latest Revision: 20260831 |
| Update Code: | 20260901 |
| DOI: | 10.1097/CCM.0000000000007103 |
| PMID: | 41914820 |
| Βάση Δεδομένων: | MEDLINE |
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