Sex and gender differences in intensive care medicine

Abstract

Despite significant advancements in critical care medicine, limited attention has been given to sex and gender disparities in management and outcomes of patients admitted to the intensive care unit (ICU). While "sex" pertains to biological and physiological characteristics, such as reproductive organs, chromosomes and sex hormones, "gender" refers more to sociocultural roles and human behavior. Unfortunately, data on gender-related topics in the ICU are lacking. Consequently, data on sex and gender-related differences in admission to the ICU, clinical course, length of stay, mortality, and post-ICU burdens, are often inconsistent. Moreover, when examining specific diagnoses in the ICU, variations can be observed in epidemiology, pathophysiology, presentation, severity, and treatment response due to the distinct impact of sex hormones on the immune and cardiovascular systems. In this narrative review, we highlight the influence of sex and gender on the clinical course, management, and outcomes of the most encountered intensive care conditions, in addition to the potential co-existence of unconscious biases which may also impact critical illness. Diagnoses with a known sex predilection will be discussed within the context of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where clinical improvement is needed. To optimize patient care and outcomes, it is crucial to comprehend and address sex and gender differences in the ICU setting and personalize management accordingly to ensure equitable, patient-centered care. Future research should focus on elucidating the underlying mechanisms driving sex and gender disparities, as well as exploring targeted interventions to mitigate these disparities and improve outcomes for all critically ill patients.

Keywords: AKI; ARDS; Cardiogenic shock; Critical illness; Post-intensive care syndrome; Septic shock; Sex and gender differences; Sex disparities.

Fig. 1

Sex and gender differences in health, diseases, and medicine

Fig. 2

Simplified conceptual model to summarize the main physiological and anatomical sex dimorphisms. Principal anatomical dimorphism between men and women regarding main illnesses related to critical care. Adapted from [–21]

Fig. 3

Consideration of sex and gender in intensive care research HRT, hormone replacement therapies

Fig. 4

Consideration of sex, gender, and unconscious bias in critical illness. DNACPR do not attempt cardiopulmonary resuscitation, ICU intensive care unit, LOS length of stay, PICS post-intensive care syndrome

Fig. 5

Sex differences in common ICU disease patterns. AKI acute kidney injury, AMI acute myocardial infarction, ARDS acute respiratory distress syndrome, ICU intensive care unit, MCS mechanical circulatory support, PCI percutaneous coronary intervention, TTM targeted temperature management