ArticleJournal of intensive care2026
Recorded body height and sex differences in lung-protective ventilation among adults with ARDS: an 11-year single-centre cohort study.
Article in Journal of intensive care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLung-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.
methodsRetrospective 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.
resultsAmong 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 < 0.001), with lower VT adherence (55.3% vs. 76.1%; p < 0.001), higher plateau and driving pressures, and higher PBW-normalised mechanical power. In 527 patients contributing 58,802 observations, the simultaneous adjusted VT model yielded a female-sex coefficient of 0.051 mL/kg PBW (95% CI, -0.273 to 0.376; p = 0.756), whereas recorded height was inversely associated with VT/kg PBW (β per cm, -0.0342; 95% CI, -0.0498 to -0.0185; p < 0.001); the sex-by-height interaction was not supported (p = 0.971). In the corresponding mechanical-power model (410 patients; 44,725 observations), the female-sex coefficient was -0.0158 J·min⁻
conclusionsUnadjusted 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.
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