Respiratory failure & ventilation
The predicted body weight equation overestimates lung sizes of female, critically ill patients: an analysis of randomized, controlled trials and real-world clinical data
Authors' conclusion
The widely used PBW equation overestimates lung volumes in female critically ill patients, resulting in excess risk of injurious driving pressures among females, mediating higher mortality.
Study context
- Population
- Mechanically ventilated, critically ill patients39.4% female
- Participants
- 30,516 participants
- Comparison
- Female vs male patients at comparable Vt/kg predicted body weight (PBW) or same PBW
- Outcome
- Risk of high driving pressures (≥ 15 cmH2O) at comparable Vt/kg PBW
Methodological detailsten randomized trials, two real-world retrospective clinical datasets
- Ten randomized trials
- Two real-world retrospective clinical datasets
Pooled result
As reported in the abstract
High driving pressures (≥ 15 cmH2O)
Each group vs maleAbsolute risk difference, % (95% CI)
Female
4.2(3.2–5.3)
Each group vs maleAdjusted odds ratio (95% CI)P value
Female
1.26(1.19–1.33)
P < 0.001Further pooled results
| Outcome | Estimate | P value |
|---|---|---|
| Anatomical lung volume at the same PBW | difference - 343 ml (95% CI - 449 to - 237) | P < 0.001 |
| Aerated lung volume at the same PBW | difference - 188 (95% CI - 282 to - 94) | P < 0.001 |
Excess 28-day mortality mediated by high driving pressures
- Proportion of excess 28-day mortality in females mediated
- 8.4%
- p < 0.001
Original publication
The predicted body weight equation overestimates lung sizes of female, critically ill patients: an analysis of randomized, controlled trials and real-world clinical data. Intensive Care Med. Published 7 May 2026. doi:10.
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