Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study.

Sunny Nijbroek , Liselotte Hol , Pien Swart , Sabrine Hemmes , Ary Serpa Neto , Jan Binnekade , Goran Hedenstierna , Samir Jaber (1, 2) , Michael Hiesmayr , Markus Hollmann , Gary Mills , Marcos Vidal Melo , Christian Putensen , Werner Schmid , Paolo Severgnini , Hermann Wrigge , Marcelo Gama de Abreu , Paolo Pelosi , Marcus Schultz

1 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]

One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients. Background: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients. Objectives: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference. Design, patients and setting: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries. Main outcome measures: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation. Results: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT. Conclusion: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.

Domaines: Sciences du Vivant [q-bio]

Sunny Nijbroek, Liselotte Hol, Pien Swart, Sabrine Hemmes, Ary Serpa Neto, et al.. Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study.. European Journal of Anaesthesiology, 2021, pp.1034-1041. ⟨10.1097/EJA.0000000000001476⟩. ⟨hal-03147887⟩