Sex Differences in Vital Organ Support Provided to ICU Patients.

Autor:	Modra LJ; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.; Intensive Care Unit, Austin Health, Melbourne, VIC, Australia., Higgins AM; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia., Pilcher DV; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.; Intensive Care Unit, Austin Health, Melbourne, VIC, Australia.; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.; Intensive Care Unit, Alfred Health, Melbourne, VIC, Australia.; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Camberwell, VIC, Australia.; Department of Intensive Care Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia., Bailey M; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia., Bellomo R; Department of Intensive Care Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2024 Jan 01; Vol. 52 (1), pp. 1-10. Date of Electronic Publication: 2023 Oct 16.
DOI:	10.1097/CCM.0000000000006058
Abstrakt:	Objectives: Critically ill women may receive less vital organ support than men but the mortality impact of this differential treatment remains unclear. We aimed to quantify sex differences in vital organ support provided to adult ICU patients and describe the relationship between sex, vital organ support, and mortality. Design: In this retrospective observational study, we examined the provision of invasive ventilation (primary outcome), noninvasive ventilation, vasoactive medication, renal replacement therapy, extracorporeal membrane oxygenation (ECMO), or any one of these five vital organ supports in women compared with men. We performed logistic regression investigating the association of sex with each vital organ support, adjusted for illness severity, diagnosis, preexisting treatment limitation, year, and hospital. We performed logistic regression for hospital mortality adjusted for the same variables, stratified by vital organ support (secondary outcome). Setting and Patients: ICU admissions in the Australia and New Zealand Intensive Care Society Adult Patient Database 2018-2021. This registry records admissions from 90% of ICUs in the two nations. Interventions: None. Measurements and Main Results: We examined 699,535 ICU admissions (43.7% women) to 199 ICUs. After adjustment, women were less likely than men to receive invasive ventilation (odds ratio [OR], 0.64; 99% CI, 0.63-0.65) and each other organ support except ECMO. Women had lower adjusted hospital mortality overall (OR, 0.94; 99% CI, 0.91-0.97). Among patients who did not receive any organ support, women had significantly lower adjusted hospital mortality (OR, 0.82; 99% CI, 0.76-0.88); among patients who received any organ support women and men were equally likely to die (OR, 1.01; 99% CI, 0.97-1.04). Conclusions: Women received significantly less vital organ support than men in ICUs in Australia and New Zealand. However, our findings suggest that women may not be harmed by this conservative approach to treatment. Competing Interests: Dr. Modra received funding from the Graeme Clark Institute of the University of Melbourne-Women in Science Technology and Mathematics Award, and the Australia and New Zealand Intensive Care Society-Peter Hicks Fellowship Award; she disclosed that she is a member of the Women in Intensive Care Medicine Network of the Australia and New Zealand Intensive Care Society. Dr Higgins received funding from a National Health and Medical Research Council Emerging Leader Fellowship (Grant #2008447). The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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