Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
Departments of Anaesthesiology and Medicine, Division of Critical Care, University of Wisconsin Hospitals & Clinics, Madison, USA.
Intensive Care Med. 2023 Oct;49(10):1155-1167. doi: 10.1007/s00134-023-07194-6. Epub 2023 Sep 7.
Despite significant advancements in critical care medicine, limited attention has been given to sex and gender disparities in management and outcomes of patients admitted to the intensive care unit (ICU). While "sex" pertains to biological and physiological characteristics, such as reproductive organs, chromosomes and sex hormones, "gender" refers more to sociocultural roles and human behavior. Unfortunately, data on gender-related topics in the ICU are lacking. Consequently, data on sex and gender-related differences in admission to the ICU, clinical course, length of stay, mortality, and post-ICU burdens, are often inconsistent. Moreover, when examining specific diagnoses in the ICU, variations can be observed in epidemiology, pathophysiology, presentation, severity, and treatment response due to the distinct impact of sex hormones on the immune and cardiovascular systems. In this narrative review, we highlight the influence of sex and gender on the clinical course, management, and outcomes of the most encountered intensive care conditions, in addition to the potential co-existence of unconscious biases which may also impact critical illness. Diagnoses with a known sex predilection will be discussed within the context of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where clinical improvement is needed. To optimize patient care and outcomes, it is crucial to comprehend and address sex and gender differences in the ICU setting and personalize management accordingly to ensure equitable, patient-centered care. Future research should focus on elucidating the underlying mechanisms driving sex and gender disparities, as well as exploring targeted interventions to mitigate these disparities and improve outcomes for all critically ill patients.
尽管重症监护医学取得了重大进展，但在重症监护病房（ICU）患者管理和结局方面，性别差异问题仍未得到足够重视。“性别”是指与生殖器官、染色体和性激素等生物学和生理学特征有关的因素，而“性别”则更多地指与社会文化角色和人类行为有关的因素。不幸的是，目前 ICU 中与性别相关的主题数据仍然缺乏。因此，关于 ICU 入院、临床病程、住院时间、死亡率和 ICU 后负担等与性别相关差异的数据往往不一致。此外，在检查 ICU 中的特定诊断时，由于性激素对免疫系统和心血管系统的明显影响，可能会观察到流行病学、病理生理学、表现、严重程度和治疗反应方面存在性别差异。在这篇叙述性综述中，我们强调了性别对最常见的重症监护条件的临床病程、管理和结局的影响，此外还存在无意识偏见的潜在共存，这也可能影响到危重病。将在生理学、解剖学和药理学方面存在已知性别倾向的诊断与性别差异的背景下进行讨论，目的是确定需要临床改进的领域。为了优化患者的护理和结局，了解和解决 ICU 中的性别差异并相应地个性化管理至关重要，以确保提供公平、以患者为中心的护理。未来的研究应侧重于阐明导致性别差异的潜在机制，并探索有针对性的干预措施，以减轻这些差异并改善所有重症患者的结局。
