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Comparative Study
. 2024 Oct 8;25(1):363.
doi: 10.1186/s12931-024-03002-x.

Differences between women and men in prolonged weaning

Evelyn Röser #  1   2 , Julia D Michels-Zetsche #  2   3 , Hilal Ersöz  2   3 , Benjamin Neetz  2   3 , Philipp Höger  2   3 , Frederik Trinkmann  2   3 , Michael M Müller  2   3 , Laura Klotz  1   2 , Konstantina Kontogianni  2   3 , Hauke Winter  1   2 , Jana Christina Dahlhoff  2   3 , Sabine Krysa  1   2 , Felix J F Herth  2   3 , Franziska C Trudzinski  4   5
Affiliations
Comparative Study

Differences between women and men in prolonged weaning

Evelyn Röser et al. Respir Res. .

Abstract

Background: In recent years, the importance of sex as a factor influencing medical care has received increasing attention in the field of intensive care medicine. The objective of this study was to examine the influence of sex in prolonged weaning.

Methods: A retrospective analysis of patients undergoing prolonged weaning at Thoraxklinik, University Hospital Heidelberg between 12/08 and 12/23 was conducted. Patients with neuromuscular diseases were excluded from the analyses. The risk factors for weaning failure in men and women were identified through stepwise cox-regression analyses.

Results: A total of 785 patients were included, of whom 313 (39.9%) were women. 77.9% of the women and 75.4% of the men were successfully weaned from invasive ventilation. In group comparisons and multivariable analyses, sex was not found to be a risk factor for weaning failure. Cox regression analyses were performed separately for both sexes on the outcome of weaning failure, adjusting for relevant covariates. The results indicated that age ≥ 65 years (HR 2.38, p < 0.001) and the duration of IMV before transfer to the weaning centre (HR 1.01/day, p < 0.001) were independent risk factors in men. In women, however, the duration of IMV before transfer (HR 1.01, p < 0.001), previous non-invasive ventilation (HR 2.9, p 0.005), the presence of critical illness polyneuropathy (HR 1.82; p = 0.040) and delirium (HR 2.50, p = 0.017) were identified as relevant risk factors. In contrast delirium was associated with a favourable weaning outcome in men (HR 0.38, p = 0.020) and nosocomial pneumonia as a reason for prolonged weaning in women (HR 0.43; p = 0.032).

Conclusion: The analyses indicate that there are sex-based differences in the risk factors associated with weaning failure. Further studies, ideally prospective, should confirm these findings to assess whether sex is a factor that should be taken into account to improve weaning outcomes.

Keywords: Invasive mechanical ventilation; Prolonged weaning; Sex-specific differences; Weaning outcome.

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Conflict of interest statement

Julia D. Michels-Zetsche, Benjamin Neetz, Michael M. Müller, Felix J.F. Herth and Franziska C. Trudzinski and Jana-Christina Dahlhoff report a relationship with Federal Joint Committee of Doctors Hospitals and Health Insurers that includes: funding grants for the PRiVENT project. Outside the submitted work: Franziska C. Trudzinski reports payment or honoraria for lectures, or reimbursement of travel expenses from Novartis AG, GlaxoSmithKline, Chiesi, Boehringer Ingelheim GmbH, Grifols, Streamed up, RG Gesellschaft für Information und Organisation mbH and AstraZeneca. Julia D. Michels-Zetsche reports payment or honoraria for lectures from AstraZeneca and reimbursement of travel expenses from CSL Behring. Frederik Trinkmann reports personal fees from Actelion, Berlin Chemie, Boehringer Ingelheim, Chiesi, Novartis, Mundipharma, TEVA, Bristol-Myers Squibb, GlaxoSmithKline, Roche, AstraZeneca, Sanofi-Aventis. Konstantina Kontogianni reports consulting fees from Cook Medical and honoraria from AstraZeneca, Berlin Chemie, Boston Scientific, Olympus medical. The other authors report no further competing interest concerning this manuscript. Hilal Ersöz reports support for attending meetings and/or travel from CSL Behring.

Figures

Fig. 1
Fig. 1
Weaning outcomes for men and women N = 785. According to German guidelines, patients were categorised as follows: category 3a: successful prolonged weaning from mechanical ventilation without the need for subsequent long-term non-invasive ventilation (NIV); category 3b: successful prolonged weaning from mechanical ventilation with the continuation of NIV and from mechanical ventilation; category 3cI: failed weaning, patients who continued to receive mechanical ventilation as an outpatient; and category 3cII: failed weaning, patients who died during weaning. The figure shows the number of patients in the individual categories as a percentage. *p < 0.005
Fig. 2
Fig. 2
Results of Cox regression analysis for Risk factors for weaning failure in the study population N = 785. The figure shows the results of the Cox regression analysis with weaning failure as outcome variable. The plot shows the Hazard Ratios with their corresponding 95% confidence intervals corresponding to the numerical values given in supplementary Table S1. IMV Invasive mechanical ventilation before transfer to the centre, CIP Critical illness polyneuropathy, BMI body mass index, NIV non-invasive ventilation
Fig. 3
Fig. 3
Results of Cox regression analysis for Risk factors for weaning failure women and in men. The figure shows the results of the Cox regression analysis with weaning failure as the outcome variable, which were carried out separately for women (A) and men (B). The plot shows the Hazard Ratios with their corresponding 95% confidence intervals corresponding to the numerical values given in supplementary Table S 2 and 3. IMV = Invasive mechanical ventilation before transfer to the centre, CIP Critical illness polyneuropathy, BMI body mass index, NIV non-invasive ventilation
See this image and copyright information in PMC

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