The Critically Ill Female Patient
Differential outcomes are present among female and male patients with critical illness, related to co-morbidity, immune response, pharmacology and the underlying physiological response to intensive care and its complications. Women are more susceptible to the effects of neuromuscular blockade, opioid receptor agonists, and beta adrenergic agents and they are more likely to develop Torsade de pointes and liver dysfunction in response to pharmacological agents. Elderly female patients with basal septal hypertrophy may respond to dobutamine by developing worsening of diastolic dysfunction and increasing left-ventricular outflow tract obstruction. There are important differences in post-traumatic stress disorder (PTSD) between genders, with women at risk for markedly worse psychological outcomes after critical illness.
KeywordsBeta-blockers Critical illness Diastolic dysfunction Dobutamine Estrogen Extracorporeal cardiac support Immune response Immunomodulation Inflammation Intensive care Pharmacokinetics Post-traumatic stress disorder (PTSD) Pregnancy Sex-hormones Sepsis Torsade de pointes (TdP) Trauma
- 3.Spoerke N, et al. Effects of ethanol intoxication and gender on blood coagulation. J Trauma. 2010;68:1106–11.Google Scholar
- 5.Wichman MW, et al. Gender differences: improved immune function in females as opposed to decreased immune function in males following haemorrhagic shock. Surg Forum 1995;46:758–9.Google Scholar
- 8.Fowler R, et al. Sex and age based differences in the delivery and outcomes of critical care. CMAJ. 2007;177(12):1513–19.Google Scholar
- 10.Vezzani A, et al. Gender disparities in the intensive care unit. Ital J Gender Specific Med. 2016;2(1):22–7.Google Scholar