Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts.

<h4>Background</h4>Studies in patients receiving invasive ventilation show important differences in use of low tidal volume (VT) ventilation (LTVV) between females and males. The aims of this study were to describe temporal changes in VT and to determine what factors drive the sex differ...

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Autores principales:	Pien Swart, Rodrigo Octavio Deliberato, Alistair E W Johnson, Tom J Pollard, Lucas Bulgarelli, Paolo Pelosi, Marcelo Gama de Abreu, Marcus J Schultz, Ary Serpa Neto
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/fdbd73436382459ca97d8102f014b058
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spelling	oai:doaj.org-article:fdbd73436382459ca97d8102f014b0582021-12-02T20:09:14ZImpact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts.1932-620310.1371/journal.pone.0253933https://doaj.org/article/fdbd73436382459ca97d8102f014b0582021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253933https://doaj.org/toc/1932-6203<h4>Background</h4>Studies in patients receiving invasive ventilation show important differences in use of low tidal volume (VT) ventilation (LTVV) between females and males. The aims of this study were to describe temporal changes in VT and to determine what factors drive the sex difference in use of LTVV.<h4>Methods and findings</h4>This is a posthoc analysis of 2 large longitudinal projects in 59 ICUs in the United States, the 'Medical information Mart for Intensive Care III' (MIMIC III) and the 'eICU Collaborative Research DataBase'. The proportion of patients under LTVV (median VT < 8 ml/kg PBW), was the primary outcome. Mediation analysis, a method to dissect total effect into direct and indirect effects, was used to understand which factors drive the sex difference. We included 3614 (44%) females and 4593 (56%) males. Median VT declined over the years, but with a persistent difference between females (from median 10.2 (9.1 to 11.4) to 8.2 (7.5 to 9.1) ml/kg PBW) vs. males (from median 9.2 [IQR 8.2 to 10.1] to 7.3 [IQR 6.6 to 8.0] ml/kg PBW) (P < .001). In females versus males, use of LTVV increased from 5 to 50% versus from 12 to 78% (difference, -27% [-29% to -25%]; P < .001). The sex difference was mainly driven by patients' body height and actual body weight (adjusted average causal mediation effect, -30% [-33% to -27%]; P < .001, and 4 [3% to 4%]; P < .001).<h4>Conclusions</h4>While LTVV is increasingly used in females and males, females continue to receive LTVV less often than males. The sex difference is mainly driven by patients' body height and actual body weight, and not necessarily by sex. Use of LTVV in females could improve by paying more attention to a correct calculation of VT, i.e., using the correct body height.Pien SwartRodrigo Octavio DeliberatoAlistair E W JohnsonTom J PollardLucas BulgarelliPaolo PelosiMarcelo Gama de AbreuMarcus J SchultzAry Serpa NetoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0253933 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Pien Swart Rodrigo Octavio Deliberato Alistair E W Johnson Tom J Pollard Lucas Bulgarelli Paolo Pelosi Marcelo Gama de Abreu Marcus J Schultz Ary Serpa Neto Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts.
description	<h4>Background</h4>Studies in patients receiving invasive ventilation show important differences in use of low tidal volume (VT) ventilation (LTVV) between females and males. The aims of this study were to describe temporal changes in VT and to determine what factors drive the sex difference in use of LTVV.<h4>Methods and findings</h4>This is a posthoc analysis of 2 large longitudinal projects in 59 ICUs in the United States, the 'Medical information Mart for Intensive Care III' (MIMIC III) and the 'eICU Collaborative Research DataBase'. The proportion of patients under LTVV (median VT < 8 ml/kg PBW), was the primary outcome. Mediation analysis, a method to dissect total effect into direct and indirect effects, was used to understand which factors drive the sex difference. We included 3614 (44%) females and 4593 (56%) males. Median VT declined over the years, but with a persistent difference between females (from median 10.2 (9.1 to 11.4) to 8.2 (7.5 to 9.1) ml/kg PBW) vs. males (from median 9.2 [IQR 8.2 to 10.1] to 7.3 [IQR 6.6 to 8.0] ml/kg PBW) (P < .001). In females versus males, use of LTVV increased from 5 to 50% versus from 12 to 78% (difference, -27% [-29% to -25%]; P < .001). The sex difference was mainly driven by patients' body height and actual body weight (adjusted average causal mediation effect, -30% [-33% to -27%]; P < .001, and 4 [3% to 4%]; P < .001).<h4>Conclusions</h4>While LTVV is increasingly used in females and males, females continue to receive LTVV less often than males. The sex difference is mainly driven by patients' body height and actual body weight, and not necessarily by sex. Use of LTVV in females could improve by paying more attention to a correct calculation of VT, i.e., using the correct body height.
format	article
author	Pien Swart Rodrigo Octavio Deliberato Alistair E W Johnson Tom J Pollard Lucas Bulgarelli Paolo Pelosi Marcelo Gama de Abreu Marcus J Schultz Ary Serpa Neto
author_facet	Pien Swart Rodrigo Octavio Deliberato Alistair E W Johnson Tom J Pollard Lucas Bulgarelli Paolo Pelosi Marcelo Gama de Abreu Marcus J Schultz Ary Serpa Neto
author_sort	Pien Swart
title	Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts.
title_short	Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts.
title_full	Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts.
title_fullStr	Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts.
title_full_unstemmed	Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts.
title_sort	impact of sex on use of low tidal volume ventilation in invasively ventilated icu patients-a mediation analysis using two observational cohorts.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/fdbd73436382459ca97d8102f014b058
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Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts.

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