Sex differences in important aspects of care in patients in the intensive care unit and the operating room

This thesis investigated sex-based differences across different clinical settings, including critically ill patients admitted to the intensive care unit and patients receiving intraoperative mechanical ventilation. Across the studies presented, consistent differences were observed between females and males in ventilatory parameters and respiratory mechanics. These differences were partly explained by body height, and to a lesser extent by body weight, but could not be fully attributed to body size alone. This suggests that intrinsic physiological differences between sexes play an important role in shaping respiratory mechanics and ventilatory needs.
The findings indicate that ventilation strategies relying solely on generalized settings may inadvertently disadvantage certain patient groups. Accurate measurement of body height, rather than estimation, appears essential for appropriate ventilator settings. In addition, a systematic approach that incorporates both tidal volume and driving pressure may help reduce sex-based disparities in ventilation management. Closed-loop ventilation strategies may further mitigate these differences by continuously adapting ventilation on a breath-by-breath basis.
From a research perspective, the results highlight the importance of explicitly accounting for sex and body size when analysing ventilatory parameters and clinical outcomes. Future studies should aim to further elucidate the physiological mechanisms underlying sex-based differences in respiratory mechanics, with the ultimate goal of improving personalized and equitable ventilation strategies.