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Publications

Journal Article Ahead of print

PubMed: 42096093 DOI: 10.1007/s00134-026-08442-1

The predicted body weight equation overestimates lung sizes of female, critically ill patients: an analysis of randomized, controlled trials and real-world clinical data.

Intensive Care Med

Authors: Dario von Wedel, Simone Redaelli, Maxime Fosset, Joris Pensier, Denys Shay, Elena Ahrens, Luca J Wachtendorf, Eva-Lotte Seibold, Aiman Suleiman, Patricia W Wu, Seth J Berkowitz, Tayran Milá, Felix Balzer, Eduardo V Costa, Boris Jung, Elias N Baedorf Kassis, Marcelo B Amato, Daniel Talmor, Maximilian S Schaefer

Affiliations

  • Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
  • Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
  • Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA. Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA. Medical Intensive Care Unit and PhyMedExp, Montpellier University Hospital, Montpellier, France. Desbrest Institute of Epidemiology and Public Health, University of Montpellier, INRIA, Montpellier, France.
  • Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, Montpellier, France.
  • Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.
  • Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, USA.
  • Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.
  • Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
  • Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
  • Divisao de Pneumologia, INCOR-Instituto Do Coracao, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil.
  • Medical Intensive Care Unit and PhyMedExp, Montpellier University Hospital, Montpellier, France.
  • Department of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
  • Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
  • Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
  • Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany.

Abstract

PURPOSE

Low tidal volume (Vt) ventilation is the standard of care among critically ill patients. Guidelines recommend scaling Vt to the predicted body weight (PBW) to avoid ventilator-induced lung injury (VILI). Concerns exist that the PBW overestimates lung volumes of critically ill females. We investigated whether this applies to clinically relevant measures of lung volume, whether PBW-guided mechanical ventilation yields comparable risk of lung stress among male and female patients, and whether this affects mortality.

METHODS

Mechanically ventilated, critically ill patients from ten randomized trials and two real-world retrospective clinical datasets were analyzed. Risk of high driving pressures (≥ 15 cmH 2O) at comparable Vt/kg PBW as well as measures of anatomical and functional lung sizes, including computed tomography-measured lung volumes at the same PBW were compared between female and male patients.

RESULTS

Among 30,516 patients (39.4% female), ventilation with comparable tidal volumes standardized to PBW (ml/kg PBW) was associated with 4.2% (95% CI 3.2-5.3; aOR 1.26, 95% CI 1.19-1.33; p < 0.001) higher absolute risk of high driving pressures among females, mediating 8.4% of excess 28-day mortality (p < 0.001). At the same PBW, female patients had lower anatomical and aerated lung volumes (- 343 ml, 95% CI - 449 to - 237, p < 0.001; and - 188, 95% CI - 282 to - 94, p < 0.001, respectively) than males.

CONCLUSIONS

The widely used PBW equation overestimates lung volumes in female critically ill patients, resulting in excess risk of injurious driving pressures among females, mediating higher mortality. Personalized mechanical ventilation by using driving pressure-guided strategies might mitigate these disparities.

MeSH

Tidal Volume, Mortality, Lung, Critical Care, Critical Illness, Body Weight, Intensive Care Units, Ventilation