Impact of Weight Extremes on Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome

Shan L. Ward, Virginia Gildengorin, Stacey L. Valentine, Anil Sapru, Martha A Q Curley, Neal Thomas, Douglas F. Willson, Heidi R. Flori

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives: To determine whether weight extremes impact clinical outcomes in pediatric acute respiratory distress syndrome. Design: Post hoc analysis of a cohort created by combining five multicenter pediatric acute respiratory distress syndrome studies. Setting: Forty-three academic PICUs worldwide. Patients: A total of 711 subjects prospectively diagnosed with pediatric acute respiratory distress syndrome. Intervention: Subjects more than 2 years were included and categorized by Center for Disease Control and Prevention body mass index z score criteria: underweight (< -1.89), normal weight (-1.89 to +1.04), overweight (+1.05 to +1.64), and obese (≥ +1.65). Subjects were stratified by direct versus indirect lung injury leading to pediatric acute respiratory distress syndrome. The primary outcome was in-hospital mortality. In survivors, secondary analyses included duration of mechanical ventilation and ICU length of stay. Measurements and Main Results: A total of 331 patients met inclusion criteria; 12% were underweight, 50% normal weight, 11% overweight, and 27% obese. Overall mortality was 20%. By multivariate analysis, body mass index category was independently associated with mortality (p = 0.004). When stratified by lung injury type, there was no mortality difference between body mass index groups with direct lung injury; however, in the indirect lung injury group, the odds of mortality in the obese were significantly lower than normal weight subjects (odds ratio, 0.11; 95% CI, 0.02-0.84). Survivors with direct lung injury had no difference in the duration of mechanical ventilation or ICU length of stay; however, those with indirect lung injury, the overweight required longer duration of mechanical ventilation than other groups (p < 0.001). Conclusions: These data support the obesity paradox in pediatric acute respiratory distress syndrome. Obese children with indirect lung injury pediatric acute respiratory distress syndrome have a lower risk of mortality. Importantly, among survivors, the overweight with indirect lung injury requires longer duration of mechanical ventilation. Our data require prospective validation to further elucidate the pathobiology of this phenomenon.

Original languageEnglish (US)
Pages (from-to)2052-2059
Number of pages8
JournalCritical care medicine
Volume44
Issue number11
DOIs
StatePublished - Nov 1 2016

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Adult Respiratory Distress Syndrome
Lung Injury
Pediatrics
Weights and Measures
Artificial Respiration
Mortality
Survivors
Body Mass Index
Thinness
Length of Stay
Centers for Disease Control and Prevention (U.S.)
Hospital Mortality
Cohort Studies
Multivariate Analysis
Obesity
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Ward, S. L., Gildengorin, V., Valentine, S. L., Sapru, A., Curley, M. A. Q., Thomas, N., ... Flori, H. R. (2016). Impact of Weight Extremes on Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome. Critical care medicine, 44(11), 2052-2059. https://doi.org/10.1097/CCM.0000000000001857
Ward, Shan L. ; Gildengorin, Virginia ; Valentine, Stacey L. ; Sapru, Anil ; Curley, Martha A Q ; Thomas, Neal ; Willson, Douglas F. ; Flori, Heidi R. / Impact of Weight Extremes on Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome. In: Critical care medicine. 2016 ; Vol. 44, No. 11. pp. 2052-2059.
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Ward, SL, Gildengorin, V, Valentine, SL, Sapru, A, Curley, MAQ, Thomas, N, Willson, DF & Flori, HR 2016, 'Impact of Weight Extremes on Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome', Critical care medicine, vol. 44, no. 11, pp. 2052-2059. https://doi.org/10.1097/CCM.0000000000001857

Impact of Weight Extremes on Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome. / Ward, Shan L.; Gildengorin, Virginia; Valentine, Stacey L.; Sapru, Anil; Curley, Martha A Q; Thomas, Neal; Willson, Douglas F.; Flori, Heidi R.

In: Critical care medicine, Vol. 44, No. 11, 01.11.2016, p. 2052-2059.

Research output: Contribution to journalArticle

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AU - Ward, Shan L.

AU - Gildengorin, Virginia

AU - Valentine, Stacey L.

AU - Sapru, Anil

AU - Curley, Martha A Q

AU - Thomas, Neal

AU - Willson, Douglas F.

AU - Flori, Heidi R.

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N2 - Objectives: To determine whether weight extremes impact clinical outcomes in pediatric acute respiratory distress syndrome. Design: Post hoc analysis of a cohort created by combining five multicenter pediatric acute respiratory distress syndrome studies. Setting: Forty-three academic PICUs worldwide. Patients: A total of 711 subjects prospectively diagnosed with pediatric acute respiratory distress syndrome. Intervention: Subjects more than 2 years were included and categorized by Center for Disease Control and Prevention body mass index z score criteria: underweight (< -1.89), normal weight (-1.89 to +1.04), overweight (+1.05 to +1.64), and obese (≥ +1.65). Subjects were stratified by direct versus indirect lung injury leading to pediatric acute respiratory distress syndrome. The primary outcome was in-hospital mortality. In survivors, secondary analyses included duration of mechanical ventilation and ICU length of stay. Measurements and Main Results: A total of 331 patients met inclusion criteria; 12% were underweight, 50% normal weight, 11% overweight, and 27% obese. Overall mortality was 20%. By multivariate analysis, body mass index category was independently associated with mortality (p = 0.004). When stratified by lung injury type, there was no mortality difference between body mass index groups with direct lung injury; however, in the indirect lung injury group, the odds of mortality in the obese were significantly lower than normal weight subjects (odds ratio, 0.11; 95% CI, 0.02-0.84). Survivors with direct lung injury had no difference in the duration of mechanical ventilation or ICU length of stay; however, those with indirect lung injury, the overweight required longer duration of mechanical ventilation than other groups (p < 0.001). Conclusions: These data support the obesity paradox in pediatric acute respiratory distress syndrome. Obese children with indirect lung injury pediatric acute respiratory distress syndrome have a lower risk of mortality. Importantly, among survivors, the overweight with indirect lung injury requires longer duration of mechanical ventilation. Our data require prospective validation to further elucidate the pathobiology of this phenomenon.

AB - Objectives: To determine whether weight extremes impact clinical outcomes in pediatric acute respiratory distress syndrome. Design: Post hoc analysis of a cohort created by combining five multicenter pediatric acute respiratory distress syndrome studies. Setting: Forty-three academic PICUs worldwide. Patients: A total of 711 subjects prospectively diagnosed with pediatric acute respiratory distress syndrome. Intervention: Subjects more than 2 years were included and categorized by Center for Disease Control and Prevention body mass index z score criteria: underweight (< -1.89), normal weight (-1.89 to +1.04), overweight (+1.05 to +1.64), and obese (≥ +1.65). Subjects were stratified by direct versus indirect lung injury leading to pediatric acute respiratory distress syndrome. The primary outcome was in-hospital mortality. In survivors, secondary analyses included duration of mechanical ventilation and ICU length of stay. Measurements and Main Results: A total of 331 patients met inclusion criteria; 12% were underweight, 50% normal weight, 11% overweight, and 27% obese. Overall mortality was 20%. By multivariate analysis, body mass index category was independently associated with mortality (p = 0.004). When stratified by lung injury type, there was no mortality difference between body mass index groups with direct lung injury; however, in the indirect lung injury group, the odds of mortality in the obese were significantly lower than normal weight subjects (odds ratio, 0.11; 95% CI, 0.02-0.84). Survivors with direct lung injury had no difference in the duration of mechanical ventilation or ICU length of stay; however, those with indirect lung injury, the overweight required longer duration of mechanical ventilation than other groups (p < 0.001). Conclusions: These data support the obesity paradox in pediatric acute respiratory distress syndrome. Obese children with indirect lung injury pediatric acute respiratory distress syndrome have a lower risk of mortality. Importantly, among survivors, the overweight with indirect lung injury requires longer duration of mechanical ventilation. Our data require prospective validation to further elucidate the pathobiology of this phenomenon.

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