Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study.
Nijbroek SG., Hol L., Swart P., Hemmes SNT., Serpa Neto A., Binnekade JM., Hedenstierna G., Jaber S., Hiesmayr M., Hollmann MW., Mills GH., Vidal Melo MF., Putensen C., Schmid W., Severgnini P., Wrigge H., Gama de Abreu M., Pelosi P., Schultz MJ., LAS VEGAS study investigators, the PROVE Network and the Clinical Trial Network of the European Society of Anaesthesiology None.
BackgroundOne 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.ObjectivesThe 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 settingThis 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 measuresWomen 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.ResultsThis 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 ConclusionIn 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.Trial registrationThe study was registered at Clinicaltrials.gov, NCT01601223.