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Management, outcomes differ for women with ARDS

John Laffey

Among patients with acute respiratory distress syndrome, shorter women were less likely to receive lower tidal volume ventilation and women with severe confirmed disease were more likely to die than men, according to a study published in the European Respiratory Journal.

“There is significant evidence of differences in patterns of health care delivery to women vs. men, and for differences in outcomes. For example, females hospitalized with coronary artery disease are less likely to undergo invasive diagnostic and therapeutic intervention despite similar rates of presentation with acute myocardial infarction, but these differences may be related to older age at presentation. In females presenting with hemorrhagic stroke, the lower intervention rate is partially explained by more complex disease and older age at presentation. In the critically ill, the impact of sex on patient management and outcome is less well understood. We wished to address these issues in a secondary analysis of the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE), a global multicenter cohort study,” John Laffey, MD, MA, FCAI, professor of anesthesia and intensive care medicine at National University of Ireland Galway, wrote in an email to Healio Pulmonology.

Laffey and colleagues analyzed 2,377 patients, including 905 women and 1,472 men, who developed ARDS and received mechanical ventilation. No differences between the sexes were noted in terms of severity of ARDS profile, severity of critical illness or progression of ARDS.

When compared with men, women received higher mean tidal volumes (8.2 mL/kg vs. 7.2 mL/kg; P < .0001) and higher mean plateau and driving pressures. Additionally, for patients in whom plateau pressure was measured, lung protective ventilation was less common among women than men (51% vs. 75%; P < .0001).

Results also demonstrated a relationship between shorter height and higher tidal volumes among men and women, but shorter women were still less likely than shorter men to receive lower tidal volumes.

Recovery also appeared to differ between men and women. Women, as compared with men, who survived had shorter duration of invasive mechanical ventilation and reduced length of hospital stay.

At 40.2% for both men and women, overall hospital mortality was similar between the sexes. However, female sex was associated with lower likelihood of survival among patients with severe “confirmed” ARDS, which included patients who initially fulfilled the Berlin ARDS criteria on day 1 and continued to do so when reassessed on day 2 (OR = 0.35; 95% CI, 0.14-0.83).

“There was some evidence in the literature already that shorter patients received less protective lung ventilation. We were surprised to find that, in comparably sized women and men, that women still received less protective ventilation. We were also concerned and surprised to find that women with confirmed severe ARDS had a higher mortality risk,” Laffey said. “These data highlight the need for better ventilatory management in females to improve their outcomes from ARDS.”

In looking to the future, Laffey noted that the researchers would like to see further research into “the barriers to the use of lung protective mechanical ventilation and development of strategies to ensure that smaller patients, particularly females, receive these protective lung ventilation strategies.” – by Melissa Foster

For more information:

John Laffey, MD, MA, FCAI, can be reached at john.laffey@nuigalway.ie.

Disclosures: The authors report no relevant financial disclosures.