Demographics, management and outcome of women and men with Acute Respiratory Distress Syndrome in the LUNG SAFE prospective cohort study.

McNicholas, Bairbre A; Madotto, Fabiana; Pham, TÃ i; Rezoagli, Emanuele; Masterson, Claire H; Horie, Shahd; Bellani, Giacomo; Brochard, Laurent; Laffey, John G

RATIONALE We wished to determine the influence of sex on the management and outcomes in acute respiratory distress syndrome (ARDS) patients in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). METHODS We assessed the effect of sex on mortality, length of stay (LOS) and duration of invasive mechanical ventilation (IMV) in patients with ARDS who underwent IMV, adjusting for plausible clinical and geographic confounders. FINDINGS Of 2377 patients with ARDS, 905 (38%) were female while 1472 (62%) were male. There were no sex differences in clinician recognition of ARDS, or critical illness severity profile. Females received higher tidal volumes (8.2±2.1 versus 7.2±1.6 mL·kg-1, p<0.0001), and higher plateau and driving pressures compared to males. Lower tidal volume ventilation was received by 50% of females compared to 74% of males p<0.0001). In shorter patients (≤1.69 m) females were significantly less likely to receive lower tidal volumes. Surviving females had a shorter duration of IMV and reduced LOS compared to males. Overall hospital mortality was similar in females (40.2%) versus males (40.2%). However, female sex was associated with higher mortality in patients with severe confirmed ARDS (odds ratio for sex (male versus female) 0.35, 95% confidence interval 0.14-0.83). INTERPRETATION Shorter females with ARDS are less likely to receive lower tidal volume ventilation, while females with severe confirmed ARDS have a higher mortality risk. These data highlight the need for better ventilatory management in females to improve their outcomes from ARDS.