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. 2011;15(6):R262.
doi: 10.1186/cc10524. Epub 2011 Nov 1.

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

SeungHye Han  1 , Greg S Martin, James P Maloney, Carl Shanholtz, Kathleen C Barnes, Stacey Murray, Jonathan E Sevransky
Affiliations

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

SeungHye Han et al. Crit Care. 2011.

Abstract

Introduction: Lung 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.

Methods: A 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.

Results: Women 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).

Conclusions: Short 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.

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Figures

Figure 1
Figure 1
Outline of the study. ALI, acute lung injury; APRV, airway pressure release ventilation; CELEG, Consortium to Evaluate Lung Edema Genes study; HFOV, high frequency oscillation ventilation.
Figure 2
Figure 2
Association of gender (women versus men) with the use of LPV: OR (95% CI). APACHE II, Acute Physiology and Chronic Health Evaluation II; CI, confidence interval; LPV, lung protective ventilation; OR, odds ratio.
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Comment in

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