Time trends in mortality and ventilatory support among women with acute respiratory failure in a respiratory ICU: a 12-year retrospective cohort study”

Background Sex-specific differences in intensive care units (ICU) outcomes are incompletely understood, particularly in respiratory ICUs. While women generally show a survival advantage in the general population, this is not consistently observed in critical care. Long-term temporal trends in women admitted to the ICU, especially during the COVID-19 pandemic, remain poorly characterized. Methods We performed a retrospective cohort study of women with acute respiratory failure admitted to a tertiary respiratory ICU in Türkiye between 2013 and 2024. Demographics, comorbidities, severity score (APACHE II), admission diagnoses, and ventilatory support modalities were analyzed. The primary outcome was ICU mortality. Secondary outcomes included annual trends in female representation, ventilatory practices, and case mix. Joinpoint regression was used to calculate annual percent change (APC) and identify significant temporal shifts, including the pandemic period. Results Among 17,670 ICU admissions, 5,712 (32.3%) were women. Female admission declined until 2017 (31%) but increased thereafter, reaching 43% in 2024 (APC + 3.4%, p = 0.003). Pneumonia admissions rose from 10% in 2013 to 26% in 2024, whereas COPD remained stable. Ventilatory support shifted substantially: NIV declined after 2018 (APC − 11.1%, p = 0.01), IMV increased after 2021 (66% in 2024), and oxygen therapy alone rose steadily (42% in 2024). NIV and IMV application peaked in 2016 (25%), decreased during 2020–2021, then increased after 2022. Female mortality decreased until 2019 but increased thereafter (APC + 11.6%, p = 0.01), diverging from male mortality, which declined after 2021. Conclusion Female ICU representation and case mix changed significantly over the study period, with pneumonia and evolving ventilatory practices contributing to rising mortality after the pandemic. These findings underscore the importance of incorporating sex- and gender-specific considerations into critical care research and practice.