性别差异与术中潮气量：LAS VEGAS 研究的新视角。
Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study.
机构信息
From the Department of Intensive Care (SGN, LH, PS, ASN, JMB, MJS), Department of Anaesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands (SGN, LH, SNTH, MWH), Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Victoria, Australia (ASN), Hedenstierna Laboratory, Department of Clinical Physiology, Uppsala University Hospital, Uppsala, Sweden (GH), Intensive Care Unit, University Hospital of Montpellier and Saint Eloi Hospital, Montpellier University, Montpellier, France (SJ), Division of Cardiac, Thoracic, Vascular Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria (MH, WS), Operating Services, Critical Care and Anaesthesia, Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Sheffield, UK (GHM), Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA (MFVM), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany (CP), Department of Biotechnology and Life Sciences, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (PS), Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle (HW), Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany (MG de A), Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova (PP), IRCCS, Ospedale Policlinico San Martino, Genova, Italy (PP), Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand (MJS) and Nuffield Department of Medicine, University of Oxford, Oxford, UK (MJS).
出版信息
Eur J Anaesthesiol. 2021 Oct 1;38(10):1034-1041. doi: 10.1097/EJA.0000000000001476.
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.
TRIAL REGISTRATION
The study was registered at Clinicaltrials.gov, NCT01601223.
背景
肺保护性通气的一个关键要素是使用小潮气量（VT）。在重症监护病房的危重病患者中，已经描述了使用小潮气量通气（LTVV）方面的性别差异。
目的
本研究旨在确定在手术室患者中是否也存在使用 LTVV 的性别差异，如果存在，是什么因素导致了这种差异。
设计、患者和设置：这是对 LAS VEGAS 的事后分析，这是一项为期一周的全球观察性研究，涉及 29 个国家的 146 家医院，共有 9864 名接受全身麻醉下术中通气的成年人患者。
主要观察指标
比较女性和男性使用 LTVV 的情况，定义为预测体重（PBW）的 8ml/kg 或以下的 VT。如果设定的 VT 是一个整数，则认为 VT 为“默认”。通过中介分析评估哪些因素可能解释术中通气时使用 LTVV 的性别差异。
结果
本分析包括 9864 例患者，其中 5425 例（55%）为女性。默认 VT 在女性和男性中都经常设置，模式 VT 为 500ml。女性的中位[IQR]VT 高于男性（8.6[7.7 至 9.6]ml/kg PBW 比 7.6[6.8 至 8.4]ml/kg PBW，P<0.001）。与男性相比，女性接受 LTVV 的可能性低两倍[68.8%比 36.0%；相对风险比 2.1（95%CI 1.9 至 2.1），P<0.001]。在中介分析中，患者的身高和实际体重（ABW）分别解释了使用 LTVV 方面性别差异的 81%和 18%；默认 VT 的使用并不能解释这种差异。
结论
在这项接受全身麻醉下术中通气的全球患者队列中，女性在术中通气期间接受的 VT 高于男性。女性在手术期间不接受 LTVV 的风险是男性的两倍。身高和 ABW 是使用 LTVV 方面性别差异的两个中介因素。
试验注册
该研究在 Clinicaltrials.gov 上注册，NCT01601223。
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