Abstract
Abstract
Background
Lung-protective ventilation (LPV) reduces mortality in ARDS, but adherence remains incomplete and women and shorter patients disproportionately receive tidal volumes above predicted-body-weight (PBW)-based targets. The relative associations of recorded sex and body height with this disparity remain uncertain.
Methods
Retrospective single-centre cohort study (January 2013 to December 2023, RWTH Aachen University Hospital surgical ICU). Adults (≥ 18 years) with Berlin-definition ARDS receiving mechanical ventilation for ≥ 72 h were included. Patient-level adherence to lung-protective targets was described, and repeated-measure PBW-normalised tidal volume and mechanical power were analysed with linear mixed-effects models containing a patient-level random intercept and fixed effects for recorded sex, centred recorded height, age, BMI, SAPS II, SOFA, ARDS aetiology, linear relative ICU day and the lowest same-day PaO₂/FiO₂ ratio.
Results
Among 798 adults (263 women [33.0%]), unadjusted analyses showed that women received higher tidal volumes per kg PBW than men (median, 7.6 vs. 6.8 mL/kg PBW; p 1
·kg PBW⁻
1
(95% CI, −0.0512 to 0.0196; p = 0.384).
Conclusions
Unadjusted analyses showed lower lung-protective ventilation adherence in women. In the simultaneous adjusted model, recorded height, but not recorded sex, was independently associated with VT/kg PBW. Because PBW incorporates both sex and height and recorded height was not validated against a reference measurement, the study does not establish mediation or measurement error as the underlying mechanism. Standardised direct height measurement and PBW-based decision support warrant prospective evaluation.