Sex-based Differences in the Use of Best Practices in Mechanically Ventilated Adults in the Intensive Care Unit: An Analysis of the Toronto Multicenter iCORE Database.

Abstract

Rationale: Patients who are critically ill and require admission to an intensive care unit (ICU) should receive the same quality of care regardless of their sex. Objectives: To determine, using population data from a multicenter database in Ontario, Canada, whether sex is associated with differences in the use of eight best practices and other interventions during the ICU care of mechanically ventilated women and men. Methods: Using a cohort of patients receiving mechanical ventilation in eight ICUs, our coprimary outcomes were differences in compliance with eight evidence-based practices between women and men (opioid administration, use of continuous sedation or opioids, sedation minimization, spontaneous breathing trials, stress ulcer prophylaxis, deep venous thrombosis [DVT] prophylaxis, physical restraint, and mobilization). All analyses were adjusted for confounders using logistic regression and restricted to patients eligible for each best practice Results: We included 19,070 (11,910 men, 7,160 women) patients who were mechanically ventilated for >4 hours. Men and women had similar opioid administration, sedation minimization, stress ulcer prophylaxis, DVT prophylaxis, and mobilization. Women were less likely to receive continuous infusions of sedation or opioids than men (adjusted odds ratio [OR], 0.86; 95% confidence interval [CI], 0.78-0.95) and less likely to be physically restrained (adjusted OR, 0.82; 95% CI, 0.74-0.89). Conclusions: In this cohort of mechanically ventilated patients, the use of evidence-based practices was similar between women and men, except for a higher use of continuous sedative or opioid infusions and physical restraints in men.