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Lack of Influence of Gender on Outcomes of Mechanically Ventilated Medical ICU Patients^*

^* From the Pulmonary and Critical Care Division (Dr. Epstein), Department of Medicine, Tupper Research Institute, New England Medical Center, Boston, MA; and Tufts University School of Medicine (Ms. Vuong), Boston, MA.

Correspondence: Scott K. Epstein, MD, FCCP, Pulmonary and Critical Care Division, Box 369, New England Medical Center, 750 Washington St, Boston, MA 02111; e-mail: scott.epstein{at}es.nemc.org

Study objectives: Recent studies combining medical and surgical patients have suggested that mortality is higher for mechanically ventilated women than for men. This study was designed to determine whether there are gender-based differences in outcomes in mechanically ventilated medical ICU (MICU) patients.

Design and setting: Prospective observational study in an MICU of a tertiary-care academic medical center.

Patients: Five hundred eighty consecutive patients admitted to the MICU service and mechanically ventilated for a minimum of 12 h.

Results: There was no difference in overall hospital mortality rate (woman, 36.3%; men, 40.4%; p > 0.2). No differences in mortality rates were noted after stratification based on age, underlying comorbid condition, APACHE (acute physiology and chronic health evaluation) II score, indication for mechanical ventilation, or acute hepatic or renal failure. Using a multiple logistic regression model, gender was not independently associated with hospital mortality. No differences were found between men and women for a number of secondary outcomes, including likelihood of undergoing weaning trials, success of weaning trials, time between onset of mechanical ventilation and extubation, total time on mechanical ventilation, rate of unplanned extubations, need for reintubation or tracheostomy, or duration of MICU and hospital stay, after the onset of mechanical ventilation. The number and timing of orders written to withhold care were comparable between men and women.

Conclusions: Using univariate and multivariate analyses, we found no differences in hospital mortality rates between mechanically ventilated men and women. Differences in the process of care or gender-based treatment bias may explain previously reported differences in outcomes.

Key Words: extubation • gender • ICU • mechanical ventilation • outcome • weaning

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