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Abstract：
BACKGROUND: In the general intensive care unit (ICU) women receive invasive mechanical ventilation (IMV) less frequently than men. We investigated whether sex differences in the use of IMV also exist in the neurocritical care unit (NCCU), where patients are intubated not only due to respiratory failure but also due to neurological impairment.
METHODS: This retrospective single-centre study included adults admitted to the NCCU of the University Hospital Zurich between January 2018 and August 2021 with neurological or neurosurgical main diagnosis. We collected data on demographics, intubation, re-intubation, tracheotomy, and duration of IMV or other forms of respiratory support from the Swiss ICU registry or the medical records. A descriptive statistics was performed. Baseline and outcome characteristics were compared by sex in the whole population and in subgroup analysis.
RESULTS: Overall, 963 patients were included. No differences between sexes in the use and duration of IMV, frequency of emergency or planned intubations, tracheostomy were found. The duration of oxygen support was longer in women (men 2 [2, 4] vs. women 3 [1, 6] days, p = 0.018), who were more often admitted due to subarachnoid hemorrhage (SAH). No difference could be found after correction for age, diagnosis of admission and severity of disease.
CONCLUSIONS: In this NCCU population and differently from the general ICU population, we found no difference by sex in the frequency and duration of IMV, intubation, reintubation, tracheotomy and non-invasive ventilation support. These results suggest that the differences in provision of care by sex reported in the general ICU population may be diagnosis-dependent. The difference in duration of oxygen supplementation observed in our population can be explained by the higher prevalence of SAH in women, where we aim for higher oxygenation targets due to the specific risk of vasospasm.
METHODS: This retrospective single-centre study included adults admitted to the NCCU of the University Hospital Zurich between January 2018 and August 2021 with neurological or neurosurgical main diagnosis. We collected data on demographics, intubation, re-intubation, tracheotomy, and duration of IMV or other forms of respiratory support from the Swiss ICU registry or the medical records. A descriptive statistics was performed. Baseline and outcome characteristics were compared by sex in the whole population and in subgroup analysis.
RESULTS: Overall, 963 patients were included. No differences between sexes in the use and duration of IMV, frequency of emergency or planned intubations, tracheostomy were found. The duration of oxygen support was longer in women (men 2 [2, 4] vs. women 3 [1, 6] days, p = 0.018), who were more often admitted due to subarachnoid hemorrhage (SAH). No difference could be found after correction for age, diagnosis of admission and severity of disease.
CONCLUSIONS: In this NCCU population and differently from the general ICU population, we found no difference by sex in the frequency and duration of IMV, intubation, reintubation, tracheotomy and non-invasive ventilation support. These results suggest that the differences in provision of care by sex reported in the general ICU population may be diagnosis-dependent. The difference in duration of oxygen supplementation observed in our population can be explained by the higher prevalence of SAH in women, where we aim for higher oxygenation targets due to the specific risk of vasospasm.
摘要：
背景：在一般重症监护病房（ICU）中，女性接受有创机械通气（IMV）的频率低于男性。我们调查了在神经重症监护病房（NCCU）中是否也存在使用IMV的性别差异，患者不仅由于呼吸衰竭，而且由于神经功能缺损而插管。
方法：这项回顾性单中心研究纳入了2018年1月至2021年8月在苏黎世大学医院NCCU接受神经或神经外科主要诊断的成年人。我们收集了人口统计数据，插管,重新插管,气管切开术,以及瑞士ICU注册或医疗记录中的IMV或其他形式的呼吸支持的持续时间。进行了描述性统计。在整个人群和亚组分析中，按性别比较了基线和结果特征。
结果：总体而言，包括963名患者。性别在IMV的使用和持续时间上没有差异，紧急或计划插管的频率，发现气管造口术。女性的氧气支持持续时间更长(男性2[2，4]vs.女性3[1,6]天，p=0.018),由于蛛网膜下腔出血（SAH）而入院的频率更高。校正年龄后没有发现差异，入院诊断和疾病的严重程度。
结论：在该NCCU人群中，与一般ICU人群不同，我们发现IMV的频率和持续时间没有性别差异，插管,再插管,气管切开术和无创通气支持。这些结果表明，在一般ICU人群中报告的按性别提供护理的差异可能取决于诊断。在我们人群中观察到的氧气补充持续时间的差异可以解释为女性SAH患病率较高，由于血管痉挛的特定风险，我们的目标是更高的氧合目标。
方法：这项回顾性单中心研究纳入了2018年1月至2021年8月在苏黎世大学医院NCCU接受神经或神经外科主要诊断的成年人。我们收集了人口统计数据，插管,重新插管,气管切开术,以及瑞士ICU注册或医疗记录中的IMV或其他形式的呼吸支持的持续时间。进行了描述性统计。在整个人群和亚组分析中，按性别比较了基线和结果特征。
结果：总体而言，包括963名患者。性别在IMV的使用和持续时间上没有差异，紧急或计划插管的频率，发现气管造口术。女性的氧气支持持续时间更长(男性2[2，4]vs.女性3[1,6]天，p=0.018),由于蛛网膜下腔出血（SAH）而入院的频率更高。校正年龄后没有发现差异，入院诊断和疾病的严重程度。
结论：在该NCCU人群中，与一般ICU人群不同，我们发现IMV的频率和持续时间没有性别差异，插管,再插管,气管切开术和无创通气支持。这些结果表明，在一般ICU人群中报告的按性别提供护理的差异可能取决于诊断。在我们人群中观察到的氧气补充持续时间的差异可以解释为女性SAH患病率较高，由于血管痉挛的特定风险，我们的目标是更高的氧合目标。
