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Female Hearts Respond Better

Arch Surg. 2002;137:578-584.

Hypothesis  Women respond better to standardized shock resuscitation compared with similarly severely injured men.

Design  Severely injured patients who met specific criteria were resuscitated using a standardized protocol with no adjustment for gender. The resuscitation protocol was used to attain and to maintain an oxygen delivery index of 600 mL/min · m² or greater (DO₂I 600) for the first 24 hours in the intensive care unit (ICU). Interventions, responses, and outcomes for the 2 cohorts were compared. Data were analyzed using analysis of variance, ², and t tests; P<.05 was considered significant.

Setting  A 20-bed regional level I trauma center ICU.

Patients  Patients at high risk of postinjury multiple organ failure (major organ or vascular injury and/or skeletal fractures, initial arterial base deficit of 6 mEq/L or greater, requirement for 6 units or more of packed red blood cells in the first 12 hours after hospital admission, or age 65 years with any 2 previous criteria).

Interventions  Pulmonary artery catheter, packed red blood cell transfusion, crystalloid fluid infusion, inotrope, and vasopressor support, as needed, in that sequence, to maintain DO₂I 600.

Main Outcome Measures  Hemodynamic response to resuscitation, fluid, and packed red blood cell volume.

Results  During 2000, 58 patients (38 men, 20 women) met criteria and were resuscitated using our standardized protocol. Demographics and outcomes were similar for both cohorts. Requirements for and responses to standardized resuscitation were also similar, except for volume loading. The female cohort required less lactated Ringer solution volume (12 ± 1 vs 8 ± 2 L, P<.05), required less Starling curve intervention (42% vs 15%, P<.05), and maintained the DO₂I goal with average pulmonary capillary wedge pressure that was less than that of the male cohort.

Conclusion  Review of prospective data from standardized shock resuscitation for female and male cohorts demonstrates that women respond better to standardized resuscitation compared with similarly severely injured men.

From the Department of Surgery (Drs McKinley, Kozar, Cocanour, Sailors, Ware, and Moore) University of Texas–Houston Medical School, and Shock Trauma Intensive Care Unit (Ms Valdivia), Memorial Hermann Hospital, Houston.

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