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Abstract
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.
- pediatrics
- obesity
- acute respiratory failure
- bilevel invasive respiratory support
- high flow nasal cannula
Footnotes
- Correspondence: Conrad Krawiec MD, Penn State Hershey Children’s Hospital, Department of Pediatrics, 500 University Drive, PO Box 850, Hershey, PA 17033–0850. E-mail: ckrawiec{at}pennstatehealth.psu.edu
Supplementary material related to this paper is available at http://www.rcjournal.com.
This work was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR002014. The authors have disclosed no conflicts of interest.
- Copyright © 2021 by Daedalus Enterprises
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