Sex difference in the risk of extubation failure in ICUs
Abstract Background Little attention has been paid to potential differences in prognosis between mechanically ventilated males and females in intensive care units (ICUs). We hypothesized that a sex gap in the risk of extubation failure in ICUs may exist. Methods Post hoc analysis of a large-scale cl...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2023-12-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-023-01225-7 |
| _version_ | 1797376796950265856 |
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| author | Arnaud W. Thille Florence Boissier Rémi Coudroy Sylvain Le Pape François Arrivé Laura Marchasson Jean-Pierre Frat Stéphanie Ragot for the REVA Research Network |
| author_facet | Arnaud W. Thille Florence Boissier Rémi Coudroy Sylvain Le Pape François Arrivé Laura Marchasson Jean-Pierre Frat Stéphanie Ragot for the REVA Research Network |
| author_sort | Arnaud W. Thille |
| collection | DOAJ |
| description | Abstract Background Little attention has been paid to potential differences in prognosis between mechanically ventilated males and females in intensive care units (ICUs). We hypothesized that a sex gap in the risk of extubation failure in ICUs may exist. Methods Post hoc analysis of a large-scale clinical trial including patients at high risk of extubation failure in ICUs, with the aim of assessing the risk of extubation failure according to sex. The primary outcome was reintubation within the 7 days following extubation. Results Out of 641 patients, 425 (66%) were males and 216 (34%) were females. Males were more likely to be admitted for cardiac arrest and to have underlying ischemic heart disease whereas females were more likely to be admitted for coma and to have obesity. Whereas the rate of reintubation at 48 h was significantly higher in males than in females (11.0% vs. 6.0%; difference, + 5.0 [95% CI, 0.2 to 9.2]; P = 0.038), the rate of reintubation at day 7 did not significantly differ between males and females (16.7% vs. 11.1%; difference, + 5.6% [95%CI, − 0.3 to 10.8], P = 0.059). Using multivariable logistic regression analysis, male sex was independently associated with reintubation within the 7 days following extubation (adjusted OR 1.70 [95% CI, 1.01 to 2.89]; P = 0.048), even after adjustment on reason for admission, body-mass index, severity score, respiratory rate before extubation, and noninvasive ventilation after extubation. Conclusion In this post hoc analysis of a clinical trial including a homogeneous subset of patients at high risk of extubation failure, sex was independently associated with reintubation. The role of sex on outcomes should be systematically examined in future studies of critically ill patients. |
| first_indexed | 2024-03-08T19:43:46Z |
| format | Article |
| id | doaj.art-bc023027e77a47d591c14f73413f0dfe |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-03-08T19:43:46Z |
| publishDate | 2023-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-bc023027e77a47d591c14f73413f0dfe2023-12-24T12:29:07ZengSpringerOpenAnnals of Intensive Care2110-58202023-12-0113111010.1186/s13613-023-01225-7Sex difference in the risk of extubation failure in ICUsArnaud W. Thille0Florence Boissier1Rémi Coudroy2Sylvain Le Pape3François Arrivé4Laura Marchasson5Jean-Pierre Frat6Stéphanie Ragot7for the REVA Research NetworkService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de PoitiersService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de PoitiersService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de PoitiersService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de PoitiersService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de PoitiersService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de PoitiersService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de PoitiersINSERM, CIC 1402 IS-ALIVE, University of PoitiersAbstract Background Little attention has been paid to potential differences in prognosis between mechanically ventilated males and females in intensive care units (ICUs). We hypothesized that a sex gap in the risk of extubation failure in ICUs may exist. Methods Post hoc analysis of a large-scale clinical trial including patients at high risk of extubation failure in ICUs, with the aim of assessing the risk of extubation failure according to sex. The primary outcome was reintubation within the 7 days following extubation. Results Out of 641 patients, 425 (66%) were males and 216 (34%) were females. Males were more likely to be admitted for cardiac arrest and to have underlying ischemic heart disease whereas females were more likely to be admitted for coma and to have obesity. Whereas the rate of reintubation at 48 h was significantly higher in males than in females (11.0% vs. 6.0%; difference, + 5.0 [95% CI, 0.2 to 9.2]; P = 0.038), the rate of reintubation at day 7 did not significantly differ between males and females (16.7% vs. 11.1%; difference, + 5.6% [95%CI, − 0.3 to 10.8], P = 0.059). Using multivariable logistic regression analysis, male sex was independently associated with reintubation within the 7 days following extubation (adjusted OR 1.70 [95% CI, 1.01 to 2.89]; P = 0.048), even after adjustment on reason for admission, body-mass index, severity score, respiratory rate before extubation, and noninvasive ventilation after extubation. Conclusion In this post hoc analysis of a clinical trial including a homogeneous subset of patients at high risk of extubation failure, sex was independently associated with reintubation. The role of sex on outcomes should be systematically examined in future studies of critically ill patients.https://doi.org/10.1186/s13613-023-01225-7Intensive care unitAirway extubationVentilator weaningSex difference |
| spellingShingle | Arnaud W. Thille Florence Boissier Rémi Coudroy Sylvain Le Pape François Arrivé Laura Marchasson Jean-Pierre Frat Stéphanie Ragot for the REVA Research Network Sex difference in the risk of extubation failure in ICUs Annals of Intensive Care Intensive care unit Airway extubation Ventilator weaning Sex difference |
| title | Sex difference in the risk of extubation failure in ICUs |
| title_full | Sex difference in the risk of extubation failure in ICUs |
| title_fullStr | Sex difference in the risk of extubation failure in ICUs |
| title_full_unstemmed | Sex difference in the risk of extubation failure in ICUs |
| title_short | Sex difference in the risk of extubation failure in ICUs |
| title_sort | sex difference in the risk of extubation failure in icus |
| topic | Intensive care unit Airway extubation Ventilator weaning Sex difference |
| url | https://doi.org/10.1186/s13613-023-01225-7 |
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