. 2024 Feb 1;25(2):147-158.

doi: 10.1097/PCC.0000000000003387. Epub 2023 Oct 31.

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

Kelsey M Gladen¹, David Tellez¹, Natalie Napolitano², Lauren R Edwards³, Ronald C Sanders Jr⁴, Taiki Kojima⁵, Matthew P Malone⁴, Justine Shults⁶, Conrad Krawiec⁷, Shashikanth Ambati⁸, Riley McCarthy¹, Aline Branca¹, Lee A Polikoff⁹, Philipp Jung¹⁰, Simon J Parsons¹¹, Palen P Mallory¹², Kavipriya Komeswaran¹³, Christopher Page-Goertz¹⁴, Megan C Toal¹⁵, G Kris Bysani¹⁶, Keith Meyer¹⁷, Fabrizio Chiusolo¹⁸, Lily B Glater-Welt¹⁹, Awni Al-Subu²⁰, Katherine Biagas²¹, Jan Hau Lee²², Michael Miksa²³, John S Giuliano Jr²⁴, Krista L Kierys²⁵, Andrea M Talukdar³, Michelle DeRusso¹², Laurence Cucharme-Crevier²⁶, Michelle Adu-Arko²⁷, Asha N Shenoi²⁸, Dai Kimura²⁹, Molly Flottman³⁰, Shantaveer Gangu²⁹, Ashley D Freeman³¹, Mark D Piehl³², G A Nuthall³³, Keiko M Tarquinio³⁴, Ilana Harwayne-Gidansky³⁵, Tatsuya Hasegawa³⁶, Erin S Rescoe³⁷, Ryan K Breuer³⁸, Mioko Kasagi³⁹, Vinay M Nadkarni⁴⁰, Akira Nishisaki⁴⁰; National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

Collaborators, Affiliations

Collaborators

National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI):
Heidi Flori, Neal Thomas, Michael Agus, Mary Dahmer, Lexie Goertzen, Robinder Khemani, Neethi Pinto, Vincent Faustino, Ann-Marie Brown, Monica Prieto, Robyn Wing, Hayley Buffman

Affiliations

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.

PMID: 37909825
PMCID: PMC10841296
DOI: 10.1097/PCC.0000000000003387

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

Kelsey M Gladen et al. Pediatr Crit Care Med. 2024.

. 2024 Feb 1;25(2):147-158.

doi: 10.1097/PCC.0000000000003387. Epub 2023 Oct 31.

Authors

Collaborators

National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI):
Heidi Flori, Neal Thomas, Michael Agus, Mary Dahmer, Lexie Goertzen, Robinder Khemani, Neethi Pinto, Vincent Faustino, Ann-Marie Brown, Monica Prieto, Robyn Wing, Hayley Buffman

Affiliations

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.

PMID: 37909825
PMCID: PMC10841296
DOI: 10.1097/PCC.0000000000003387

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.

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Conflict of interest statement

Ms. Napolitano’s, Dr. Shults’s, Dr. Nadkarni’s, and Dr. Nishisaki’s institution received funding from the Agency for Healthcare Research and Quality (R18HS024511). Ms. Napolitano’s institution received funding from Dräger, Actuated Medical, and Philips Respironics; they received support for article research from Timpel and VERO-Biotech. Dr. Krawiec received funding from New England Journal of Medicine Healer Cases and Carle Illinois School of Medicine Admissions Committee. Dr. Polikoff received funding from Novavax. Dr. Lee’s institution received funding from National Research Medical Council, Singapore. Dr. Shenoi is an elected member of the Society of Critical Care Medicine (SCCM) Council of the SCCM. Dr. Peihl disclosed that he is founder and Chief Medical Officer of 410 Medical; his institution received funding the Department of Defense (grants: USSOCOM W81XWH-22-C-0002, USAF SBIR AF212-CSO1 Phase II, F2-15653 USAF, SBIR AF211-CSO1 Phase II, F2-15254). Dr. Hasegawa disclosed work for hire. Dr. Nishisaki’s institution received funding from Chiesi USA, AHRA, and the National Institute of Child Health and Human Development. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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1. Li S, Hsieh TC, Rehder KJ, et al.: Frequency of desaturation and association with hemodynamic adverse events during tracheal intubations in PICUs. Pediatr Crit Care Med 2018; 19(1):e41–e50 - PubMed
1. Parker MM, Nuthall G, Brown C 3rd, et al.: Relationship between adverse tracheal intubation associated events and PICU outcomes. Pediatr Crit Care Med 2017; 18(4):310–318 - PMC - PubMed
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Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020)

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical