Research
Short women with severe sepsis-related acute lung injury receive lung protective ventilation less frequently: an observational cohort study
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* Corresponding author: SeungHye Han shan@jhsph.edu
1 Critical Care Medicine Department, National Institute of Health, 10 Center Drive, Bethesda, MD 20892, USA
2 Division of Pulmonary, Allergy and Critical Care, Emory University, 49 Jesse Hill Jr. Drive SE. Atlanta, GA 30303, USA
3 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, 4200 East 9th Avenue, Denver, CO 80262, USA
4 Division of Pulmonary and Critical Care, University of Maryland, 22 S. Greene Street, Baltimore, MD 21201, USA
5 Division of Allergy and Clinical Immunology, Johns Hopkins University, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
6 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
Critical Care 2011, 15:R262 doi:10.1186/cc10524
See related commentary by Dickson and Hyzy, http://ccforum.com/content/15/6/1010
Published: 1 November 2011Abstract
Introduction
Lung protective ventilation (LPV) has been shown to improve survival and the duration of mechanical ventilation in acute lung injury (ALI) patients. Mortality of ALI may vary by gender, which could result from treatment variability. Whether gender is associated with the use of LPV is not known.
Methods
A total of 421 severe sepsis-related ALI subjects in the Consortium to Evaluate Lung Edema Genetics from seven teaching hospitals between 2002 and 2008 were included in our study. We evaluated patients' tidal volume, plateau pressure and arterial pH to determine whether patients received LPV during the first two days after developing ALI. The odds ratio of receiving LPV was estimated by a logistic regression model with robust and cluster options.
Results
Women had similar characteristics as men with the exception of lower height and higher illness severity, as measured by Acute Physiology and Chronic Health Evaluation (APACHE) II score. 225 (53%) of the subjects received LPV during the first two days after ALI onset; women received LPV less frequently than men (46% versus 59%, P < 0.001). However, after adjustment for height and severity of illness (APACHE II), there was no difference in exposure to LPV between men and women (P = 0.262).
Conclusions
Short people are less likely to receive LPV, which seems to explain the tendency of clinicians to adhere to LPV less strictly in women. Strategies to standardize application of LPV, independent of differences in height and severity of illness, are necessary.