Differences between women and men in prolonged weaning.

IF 5.8 2区 医学 Q1 Medicine
Evelyn Röser, Julia D Michels-Zetsche, Hilal Ersöz, Benjamin Neetz, Philipp Höger, Frederik Trinkmann, Michael M Müller, Laura Klotz, Konstantina Kontogianni, Hauke Winter, Jana Christina Dahlhoff, Sabine Krysa, Felix J F Herth, Franziska C Trudzinski
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Abstract

Background: In recent years, the importance of sex as a factor influencing medical care has received increasing attention in the field of intensive care medicine. The objective of this study was to examine the influence of sex in prolonged weaning.

Methods: A retrospective analysis of patients undergoing prolonged weaning at Thoraxklinik, University Hospital Heidelberg between 12/08 and 12/23 was conducted. Patients with neuromuscular diseases were excluded from the analyses. The risk factors for weaning failure in men and women were identified through stepwise cox-regression analyses.

Results: A total of 785 patients were included, of whom 313 (39.9%) were women. 77.9% of the women and 75.4% of the men were successfully weaned from invasive ventilation. In group comparisons and multivariable analyses, sex was not found to be a risk factor for weaning failure. Cox regression analyses were performed separately for both sexes on the outcome of weaning failure, adjusting for relevant covariates. The results indicated that age ≥ 65 years (HR 2.38, p < 0.001) and the duration of IMV before transfer to the weaning centre (HR 1.01/day, p < 0.001) were independent risk factors in men. In women, however, the duration of IMV before transfer (HR 1.01, p < 0.001), previous non-invasive ventilation (HR 2.9, p 0.005), the presence of critical illness polyneuropathy (HR 1.82; p = 0.040) and delirium (HR 2.50, p = 0.017) were identified as relevant risk factors. In contrast delirium was associated with a favourable weaning outcome in men (HR 0.38, p = 0.020) and nosocomial pneumonia as a reason for prolonged weaning in women (HR 0.43; p = 0.032).

Conclusion: The analyses indicate that there are sex-based differences in the risk factors associated with weaning failure. Further studies, ideally prospective, should confirm these findings to assess whether sex is a factor that should be taken into account to improve weaning outcomes.

女性和男性在延长断奶时间方面的差异。
背景:近年来,性别作为影响医疗护理的重要因素在重症监护医学领域受到越来越多的关注。本研究旨在探讨性别对长期断奶的影响:方法:对海德堡大学医院胸腔内科在 2008 年 12 月 12 日至 2008 年 12 月 23 日期间接受长期断奶的患者进行了回顾性分析。分析中排除了患有神经肌肉疾病的患者。通过逐步考克斯回归分析确定了男性和女性断奶失败的风险因素:结果:共纳入 785 名患者,其中 313 名(39.9%)为女性。77.9%的女性和75.4%的男性成功脱离了有创通气。在分组比较和多变量分析中,没有发现性别是断流失败的风险因素。在对相关协变量进行调整后,分别对男女进行了断奶失败结果的 Cox 回归分析。结果表明,年龄≥65 岁(HR 2.38,p 结论:年龄≥65 岁是断奶失败的危险因素:分析表明,断奶失败的相关风险因素存在性别差异。进一步的研究(最好是前瞻性研究)应证实这些发现,以评估性别是否是改善断奶结果应考虑的因素。
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来源期刊
Respiratory Research
Respiratory Research RESPIRATORY SYSTEM-
CiteScore
9.70
自引率
1.70%
发文量
314
审稿时长
4-8 weeks
期刊介绍: Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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