Publication: Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts
Issued Date
2021-07-01
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19326203
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2-s2.0-85110166128
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Mahidol University
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SCOPUS
Bibliographic Citation
PLoS ONE. Vol.16, No.7 July (2021)
Suggested Citation
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. PLoS ONE. Vol.16, No.7 July (2021). doi:10.1371/journal.pone.0253933 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/79341
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Title
Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts
Other Contributor(s)
Universitätsklinikum Carl Gustav Carus Dresden
IRCCS San Martino Polyclinic Hospital
Università degli Studi di Genova
Massachusetts Institute of Technology
Monash University
Hospital Israelita Albert Einstein
Mahidol University
Nuffield Department of Medicine
Universidade de São Paulo
Amsterdam UMC
Outcomes Research Consortium
IRCCS San Martino Polyclinic Hospital
Università degli Studi di Genova
Massachusetts Institute of Technology
Monash University
Hospital Israelita Albert Einstein
Mahidol University
Nuffield Department of Medicine
Universidade de São Paulo
Amsterdam UMC
Outcomes Research Consortium
Abstract
Background 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. Methods and findings 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). Conclusions 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.