OBJECTIVES: 

To evaluate and synthesize the available literature on sex differences in the treatment of adult ICU patients.

DATA SOURCES: 

MEDLINE and EMBASE.

STUDY SELECTION: 

Two reviewers independently screened publications to identify observational studies of adult ICU patients that explicitly examined the association between sex and ICU treatment—specifically, mechanical ventilation, renal replacement therapy, and length of stay.

DATA EXTRACTION: 

We extracted data independently and in duplicate: mean age, illness severity, use of mechanical ventilation and renal replacement therapy, and length of stay in ICU and hospital. We assessed risk of bias using the Newcastle-Ottawa Scale. We used a DerSimonian-Laird random-effects model to calculate pooled odds ratios (ORs) and mean differences between women and men.

DATA SYNTHESIS: 

We screened 4,098 publications, identifying 21 eligible studies with 545,538 participants (42.7% women). The study populations ranged from 246 to 261,255 participants (median 4,420). Most studies (76.2%) were at high risk of bias in at least one domain, most commonly representativeness or comparability. Women were less likely than men to receive invasive mechanical ventilation (OR, 0.83; 95% CI, 0.77–0.89; I² = 90.4%) or renal replacement therapy (OR, 0.79; 95% CI, 0.70–0.90; I² = 76.2%). ICU length of stay was shorter in women than men (mean difference, –0.24 d; 95% CI, –0.37 to –0.12; I² = 89.9%). These findings persisted in meta-analysis of data adjusted for illness severity and other confounders and also in sensitivity analysis excluding studies at high risk of bias. There was no significant sex difference in duration of mechanical ventilation or hospital length of stay.

CONCLUSIONS: 

Women were less likely than men to receive mechanical ventilation or renal replacement therapy and had shorter ICU length of stay than men. There is substantial heterogeneity and risk of bias in the literature; however, these findings persisted in sensitivity analyses.

中文翻译：

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成人重症监护患者治疗中的性别差异：系统回顾和荟萃分析

目标： 

评估和综合有关成人 ICU 患者治疗中性别差异的现有文献。

数据源： 

MEDLINE 和 EMBASE。

研究选择： 

两名评审员独立筛选出版物，以确定针对成人 ICU 患者的观察性研究，这些研究明确检查了性别与 ICU 治疗（特别是机械通气、肾脏替代治疗和住院时间）之间的关联。

数据提取： 

我们独立且重复地提取数据：平均年龄、疾病严重程度、机械通气和肾脏替代疗法的使用以及在 ICU 和医院的住院时间。我们使用纽卡斯尔-渥太华量表评估偏倚风险。我们使用 DerSimonian-Laird 随机效应模型来计算女性和男性之间的汇总比值比 (OR) 和平均差异。

数据综合： 

我们筛选了 4,098 篇出版物，确定了 21 项符合条件的研究，涉及 545,538 名参与者（42.7% 为女性）。研究人群范围为 246 至 261,255 名参与者（中位数为 4,420 人）。大多数研究（76.2%）在至少一个领域存在高偏倚风险，最常见的是代表性或可比性。女性接受有创机械通气（OR，0.83；95% CI，0.77–0.89；I ² = 90.4%）或肾脏替代治疗（OR，0.79；95% CI，0.70–0.90；I ² = 76.2%）。女性的 ICU 住院时间比男性短（平均差，–0.24 天；95% CI，–0.37 至 –0.12；I ² = 89.9%）。这些发现在针对疾病严重程度和其他混杂因素进行调整的数据荟萃分析中以及在排除高偏倚风险的研究的敏感性分析中都得到了证实。机械通气持续时间或住院时间没有显着的性别差异。

结论： 

女性接受机械通气或肾脏替代治疗的可能性低于男性，且 ICU 住院时间也比男性短。文献中存在显着的异质性和偏倚风险；然而，这些发现在敏感性分析中仍然存在。