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. 2023 Dec 19;13(1):130.
doi: 10.1186/s13613-023-01225-7.

Sex difference in the risk of extubation failure in ICUs

Arnaud W Thille  1   2 , Florence Boissier  3   4 , Rémi Coudroy  3   4 , Sylvain Le Pape  3 , François Arrivé  3 , Laura Marchasson  3 , Jean-Pierre Frat  3   4 , Stéphanie Ragot  4 ; REVA Research Network
Collaborators, Affiliations

Sex difference in the risk of extubation failure in ICUs

Arnaud W Thille et al. Ann Intensive Care. .

Abstract

Background: Little attention has been paid to potential differences in prognosis between mechanically ventilated males and females in intensive care units (ICUs). We hypothesized that a sex gap in the risk of extubation failure in ICUs may exist.

Methods: Post hoc analysis of a large-scale clinical trial including patients at high risk of extubation failure in ICUs, with the aim of assessing the risk of extubation failure according to sex. The primary outcome was reintubation within the 7 days following extubation.

Results: Out of 641 patients, 425 (66%) were males and 216 (34%) were females. Males were more likely to be admitted for cardiac arrest and to have underlying ischemic heart disease whereas females were more likely to be admitted for coma and to have obesity. Whereas the rate of reintubation at 48 h was significantly higher in males than in females (11.0% vs. 6.0%; difference, + 5.0 [95% CI, 0.2 to 9.2]; P = 0.038), the rate of reintubation at day 7 did not significantly differ between males and females (16.7% vs. 11.1%; difference, + 5.6% [95%CI, - 0.3 to 10.8], P = 0.059). Using multivariable logistic regression analysis, male sex was independently associated with reintubation within the 7 days following extubation (adjusted OR 1.70 [95% CI, 1.01 to 2.89]; P = 0.048), even after adjustment on reason for admission, body-mass index, severity score, respiratory rate before extubation, and noninvasive ventilation after extubation.

Conclusion: In this post hoc analysis of a clinical trial including a homogeneous subset of patients at high risk of extubation failure, sex was independently associated with reintubation. The role of sex on outcomes should be systematically examined in future studies of critically ill patients.

Keywords: Airway extubation; Intensive care unit; Sex difference; Ventilator weaning.

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Conflict of interest statement

No conflicts of interests in relation with the manuscript. AWT, RC, and JPF received fees from Fisher&Paykel (travel expense coverage to attend scientific meetings and payments for lectures), outside the present work.

Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis of time from extubation to reintubation according to sex. The rate of reintubation within the 7 days following extubation was 16.7% in males (blue line) and 11.1% in females (orange line); P = 0.066 using log-rank test
See this image and copyright information in PMC

References

    1. Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013;187(12):1294–1302. doi: 10.1164/rccm.201208-1523CI. - DOI - PubMed
    1. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112(1):186–192. doi: 10.1378/chest.112.1.186. - DOI - PubMed
    1. Frutos-Vivar F, Esteban A, Apezteguia C, González M, Arabi Y, Restrepo MI, et al. Outcome of reintubated patients after scheduled extubation. J Crit Care. 2011;26(5):502–509. doi: 10.1016/j.jcrc.2010.12.015. - DOI - PubMed
    1. Oczkowski S, Ergan B, Bos L, Chatwin M, Ferrer M, Gregoretti C, et al. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J. 2022;59(4). - PubMed
    1. Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2):1602426. doi: 10.1183/13993003.02426-2016. - DOI - PubMed

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