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Impact of Body Mass Index and Initial Respiratory Support on Pediatric Subjects in Acute Respiratory Failure.

BACKGROUND: It is unknown how the initial choice of respiratory support by pediatric ICU providers contributes to outcomes of nonintubated obese children with respiratory failure. We hypothesized that body mass index and the type of initial respiratory support applied are associated with poor clinic...

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Published in:Respiratory Care Vol. 66; no. 9; pp. 1425 - 1433
Main Authors: Schlueter, Derika, Kovaleski, Curtis, Walter, Vonn, Thomas, Neal J., Krawiec, Conrad
Format: research tables/charts Journal Article
Published: Mary Ann Liebert, Inc. Sep2021
Online Access:View this record in EBSCOhost
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      dt: Sep2021
      vid: 66
      iid: 9
      pid: 1365
      pub: Mary Ann Liebert, Inc.
      place: New Rochelle, New York
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        10.4187/respcare.08735
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      tig:
        atl: Impact of Body Mass Index and Initial Respiratory Support on Pediatric Subjects in Acute Respiratory Failure.
      aug:
        au:
          Schlueter, Derika
          Kovaleski, Curtis
          Walter, Vonn
          Thomas, Neal J.
          Krawiec, Conrad
        affil: Pennsylvania State College of Medicine, Hershey, Pennsylvania
      sug:
        subj:
          Pediatric Obesity Complications
          Respiratory Failure Therapy
          Body Mass Index
          Respiration, Artificial Methods
          Outcomes (Health Care)
          Intensive Care Units, Pediatric
          Human
          Funding Source
          Retrospective Design
          Record Review
          Child, Preschool
          Child
          Adolescence
          Odds Ratio
          Confidence Intervals
          Descriptive Statistics
          Multivariate Analysis
          Multiple Logistic Regression
          Length of Stay
          Intubation, Intratracheal
          Continuous Positive Airway Pressure
          Scales
          Respiratory Failure Mortality
          Nasal Cannula
          Risk Assessment
          Inpatients
          Male
          Female
          Decision Making, Clinical
          Child, Preschool: 2-5 years
          Child: 6-12 years
          Adolescent: 13-18 years
          Male
          Female
      ab: BACKGROUND: It is unknown how the initial choice of respiratory support by pediatric ICU providers contributes to outcomes of nonintubated obese children with respiratory failure. We hypothesized that body mass index and the type of initial respiratory support applied are associated with poor clinical outcomes in patients who carry respiratory failure-associated diagnoses. METHODS: This is a retrospective analysis of de-identified patient data obtained from the Virtual PICU System database (2009--2018). We included subjects 2--18 y old who received bi-level positive airway pressure/CPAP or high-flow nasal cannula as the initial respiratory support and were assigned respiratory failure-associated diagnoses (ie, acute hypoxic respiratory failure). The study population was divided into 2 body mass index percentile groups, underweight/healthy weight (< 85th percentile) and overweight/obese (≥ 85th percentile), and subjects were evaluated for the following outcomes: endotracheal intubation requirement, medical and physical PICU length of stay, and mortality scores. RESULTS: A total of 1,721 subjects were included: 1,091 (63.4%) underweight/healthy weight and 630 (36.6%) overweight/obese. Body mass index percentile was not associated with the initial respiratory support utilized (odds ratio 0.961 [95% CI 0.79--1.17], P = .73). Multivariable logistic regression analysis demonstrated that the odds of requiring endotracheal intubation (odds ratio 1.60 [95% CI 1.10--2.35], P = .02) were significantly higher in overweight/obese subjects initially placed on high-flow nasal cannula. Body mass index and bi-level positive airway pressure/CPAP therapy were both positively associated with medical and physical PICU length of stay, Pediatric Risk of Mortality Score 3 (PRISM3) scores, and Pediatric Index of Mortality 2 (PIM2) scores when separate multivariable models were fit for these 4 response variables. CONCLUSIONS: The selection of respiratory support may place overweight/obese pediatric patients at higher risk for endotracheal intubation. Due to methodological limitations, we were unable to draw conclusions about the initial approach to the respiratory management of overweight/obese pediatric patients. Further investigation may be warranted.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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