Sex differences in the use of mechanical ventilation in a neurointensive care population: a retrospective study

Abstract

Background: In the general intensive care unit (ICU) women receive invasive mechanical ventilation (IMV) less frequently than men. We investigated whether sex differences in the use of IMV also exist in the neurocritical care unit (NCCU), where patients are intubated not only due to respiratory failure but also due to neurological impairment.

Methods: This retrospective single-centre study included adults admitted to the NCCU of the University Hospital Zurich between January 2018 and August 2021 with neurological or neurosurgical main diagnosis. We collected data on demographics, intubation, re-intubation, tracheotomy, and duration of IMV or other forms of respiratory support from the Swiss ICU registry or the medical records. A descriptive statistics was performed. Baseline and outcome characteristics were compared by sex in the whole population and in subgroup analysis.

Results: Overall, 963 patients were included. No differences between sexes in the use and duration of IMV, frequency of emergency or planned intubations, tracheostomy were found. The duration of oxygen support was longer in women (men 2 [2, 4] vs. women 3 [1, 6] days, p = 0.018), who were more often admitted due to subarachnoid hemorrhage (SAH). No difference could be found after correction for age, diagnosis of admission and severity of disease.

Conclusion: In this NCCU population and differently from the general ICU population, we found no difference by sex in the frequency and duration of IMV, intubation, reintubation, tracheotomy and non-invasive ventilation support. These results suggest that the differences in provision of care by sex reported in the general ICU population may be diagnosis-dependent. The difference in duration of oxygen supplementation observed in our population can be explained by the higher prevalence of SAH in women, where we aim for higher oxygenation targets due to the specific risk of vasospasm.

Keywords: Gender medicine; Invasive mechanical ventilation; Neurocritical care; Sex.

Fig. 1

Flowchart on patients’ inclusion and exclusion

Fig. 2

Comparisons between females and males on: A intubation type (none/ planned/ emergency); B frequency of ventilation support, C reintubation, D tracheotomy, and E frequency of respiratory comorbidities

Fig. 3

Comparisons between females and males on: A duration of hospital stay, B duration of neurocritical care unit stay, C duration of oxygen support, D duration of ventilation support, and E number of ventilator free days (all expressed in days)