Short women with severe sepsis-related acute lung injury receive lung protective ventilation less frequently: an observational cohort study

Seunghye Han,Greg S Martin,Carl Shanholtz,Stacey Murray,Jonathan E Sevransky,Kathleen C Barnes,James P Maloney

doi:10.1186/cc10524

Abstract

IntroductionLung protective ventilation (LPV) has been shown to improve survival and the duration of mechanical ventilation in acute lung injury (ALI) patients. Mortality of ALI may vary by gender, which could result from treatment variability. Whether gender is associated with the use of LPV is not known.MethodsA total of 421 severe sepsis-related ALI subjects in the Consortium to Evaluate Lung Edema Genetics from seven teaching hospitals between 2002 and 2008 were included in our study. We evaluated patients' tidal volume, plateau pressure and arterial pH to determine whether patients received LPV during the first two days after developing ALI. The odds ratio of receiving LPV was estimated by a logistic regression model with robust and cluster options.ResultsWomen had similar characteristics as men with the exception of lower height and higher illness severity, as measured by Acute Physiology and Chronic Health Evaluation (APACHE) II score. 225 (53%) of the subjects received LPV during the first two days after ALI onset; women received LPV less frequently than men (46% versus 59%, P < 0.001). However, after adjustment for height and severity of illness (APACHE II), there was no difference in exposure to LPV between men and women (P = 0.262).ConclusionsShort people are less likely to receive LPV, which seems to explain the tendency of clinicians to adhere to LPV less strictly in women. Strategies to standardize application of LPV, independent of differences in height and severity of illness, are necessary.

Highlights

Lung protective ventilation (LPV) has been shown to improve survival and the duration of mechanical ventilation in acute lung injury (ALI) patients
Severe sepsis was defined according to Society of Critical Care Medicine/American College of Chest Physicians Consensus Definitions [12]; ALI was defined as mechanically ventilated patients who met the American-European Consensus Definitions [13]
The exposures we considered are listed in Table 1: patient-related factors and severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE) Acute Physiology and Chronic Health Evaluation II (II) score [15] and the ratio of partial pressure of arterial oxygen (PaO2) and fraction of inspired oxygen (FiO2))

Summary

Introduction

Lung protective ventilation (LPV) has been shown to improve survival and the duration of mechanical ventilation in acute lung injury (ALI) patients. The use of a lung protective ventilation (LPV) strategy has been shown to reduce mortality rates in intubated ALI patients [7]. Men and women have different mortality rates in ALI [8]. Women may have different incidence of ALI and different prevalence of ALI, or different case fatality rates from ALI than men. It has been reported that there is gender difference in genetic susceptibility to acute respiratory distress syndrome (ARDS) [9]. Differential care by gender in patients without ALI who received mechanical ventilation [10,11] has been reported

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