Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013

Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013–2020)

Published:2023-10-31 Issue:2 Volume:25 Page:147-158
ISSN:1529-7535
Container-title:Pediatric Critical Care Medicine
language:en
Short-container-title:

Author:

Gladen Kelsey M.¹,Tellez David¹,Napolitano Natalie²,Edwards Lauren R.³,Sanders Ronald C.⁴,Kojima Taiki⁵,Malone Matthew P.⁴,Shults Justine⁶,Krawiec Conrad⁷,Ambati Shashikanth⁸,McCarthy Riley¹,Branca Aline¹,Polikoff Lee A.⁹,Jung Philipp¹⁰,Parsons Simon J.¹¹,Mallory Palen P.¹²,Komeswaran Kavipriya¹³,Page-Goertz Christopher¹⁴,Toal Megan C.¹⁵,Bysani G. Kris¹⁶,Meyer Keith¹⁷,Chiusolo Fabrizio¹⁸,Glater-Welt Lily B.¹⁹,Al-Subu Awni²⁰,Biagas Katherine²¹,Hau Lee Jan²²,Miksa Michael²³,Giuliano John S.²⁴,Kierys Krista L.²⁵,Talukdar Andrea M.³,DeRusso Michelle¹²,Cucharme-Crevier Laurence²⁶,Adu-Arko Michelle²⁷,Shenoi Asha N.²⁸,Kimura Dai²⁹,Flottman Molly³⁰,Gangu Shantaveer²⁹,Freeman Ashley D.³¹,Piehl Mark D.³²,Nuthall G. A.³³,Tarquinio Keiko M.³⁴,Harwayne-Gidansky Ilana³⁵,Hasegawa Tatsuya³⁶,Rescoe Erin S.³⁷,Breuer Ryan K.³⁸,Kasagi Mioko³⁹,Nadkarni Vinay M.⁴⁰,Nishisaki Akira⁴⁰,

Affiliation:

1. Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children’s Hospital, Phoenix, AZ.

2. Respiratory Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA.

3. Division of Critical Care Medicine, Department of Pediatrics, Children’s Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE.

4. Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AR.

5. Department of Anesthesiology, Aichi Children’s Health and Medical Center, Obu, Aichi, Japan.

6. Department of Biostatistics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

7. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children’s Hospital, Hershey, PA.

8. Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical Center, Albany, NY.

9. Division of Critical Care Medicine, Department of Pediatrics, The Warren Alpert Medical School at Brown University, Providence, RI.

10. Department of Pediatrics, University Children’s Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany.

11. Department of Pediatrics, Section of Critical Care Medicine, Alberta Children’s Hospital, Calgary, AB, Canada.

12. Department of Pediatrics, Duke University, Durham, NC.

13. Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS.

14. Pediatric Critical Care Medicine, Department of Pediatrics, Akron Children’s Hospital, Akron, OH.

15. Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY.

16. Pediatric Critical Care Medicine, Department of Pediatrics, Medical City Children’s Hospital, Dallas, TX.

17. Division of Critical Care Medicine, Nicklaus Children’s Hospital, Herber Wertheim College of Medicine Florida International University, Miami, FL.

18. Anesthesia and Critical Care Medicine, ARCO, Bambino Gesú Children’s Hospital, Rome, Italy.

19. Division of Pediatric Critical Care, Cohen Children’s Medical Center of New York, Queens, NY.

20. Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.

21. Pediatric Critical Care Medicine, Department of Pediatrics, The Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.

22. Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore.

23. Pediatric Critical Care Medicine, Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY.

24. Department of Pediatrics, Section of Critical Care Medicine, Yale University School of Medicine, New Haven, CT.

25. Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA.

26. Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada.

27. Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia, Charlottesville, VA.

28. Pediatric Critical Care Medicine, Department of Pediatrics, University of Kentucky, Lexington, KY.

29. Critical Care Medicine, Department of Pediatrics, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL.

30. Pediatric Critical Care Medicine, Department of Pediatrics, University of Louisville, Norton Children’s Hospital, Louisville, KY.

31. Pediatric Critical Care Medicine, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA.

32. Pediatric Critical Care Medicine, Department of Pediatrics, WakeMed Children’s Hospital, Raleigh, NC.

33. Pediatric Critical Care, Department of Pediatrics, Starship Children’s Hospital, Auckland, New Zealand.

34. Pediatric Critical Care Medicine, Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, GA.

35. Pediatric Critical Care Medicine, Department of Pediatrics, Bernard and Millie Duker Children’s Hospital, Albany, NY.

36. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Aichi Children’s Health and Medical Center, Obu, Aichi, Japan.

37. Division of Pediatric Critical Care, Maria Fareri Children’s Hospital at Westchester Medical Center, Valhalla, NY.

38. Division of Critical Care Medicine, John R. Oishei Children’s Hospital, Buffalo, NY.

39. Pediatric Critical Care and Emergency Medicine, Department of Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan.

40. Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Abstract

OBJECTIVES: Extremes of patient body mass index are associated with difficult intubation and increased morbidity in adults. We aimed to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe peri-intubation hypoxemia (pulse oximetry oxygen saturation < 80%) in critically ill children. DESIGN/SETTING: Retrospective cohort using the National Emergency Airway for Children registry dataset of 2013–2020. PATIENTS: Critically ill children, 0 to 17 years old, undergoing TI in PICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Registry data from 24,342 patients who underwent TI between 2013 and 2020 were analyzed. Patients were categorized using the Centers for Disease Control and Prevention weight-for-age chart: normal weight (5th–84th percentile) 57.1%, underweight (< 5th percentile) 27.5%, overweight (85th to < 95th percentile) 7.2%, and obese (≥ 95th percentile) 8.2%. Underweight was most common in infants (34%); obesity was most common in children older than 8 years old (15.1%). Underweight patients more often had oxygenation and ventilation failure (34.0%, 36.2%, respectively) as the indication for TI and a history of difficult airway (16.7%). Apneic oxygenation was used more often in overweight and obese patients (19.1%, 19.6%) than in underweight or normal weight patients (14.1%, 17.1%; p < 0.001). TIAEs and/or hypoxemia occurred more often in underweight (27.1%) and obese (24.3%) patients (p < 0.001). TI in underweight children was associated with greater odds of adverse airway outcome compared with normal weight children after adjusting for potential confounders (underweight: adjusted odds ratio [aOR], 1.09; 95% CI, 1.01–1.18; p = 0.016). Both underweight and obesity were associated with hypoxemia after adjusting for covariates and site clustering (underweight: aOR, 1.11; 95% CI, 1.02–1.21; p = 0.01 and obesity: aOR, 1.22; 95% CI, 1.07–1.39; p = 0.002). CONCLUSIONS: In underweight and obese children compared with normal weight children, procedures around the timing of TI are associated with greater odds of adverse airway events.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Pediatrics, Perinatology and Child Health

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