Impact of Obesity on Outcomes in Critically Ill Children

Purpose: To examine whether obesity confers a protective effect on critically ill pediatric patients, similar to what has been reported in critically ill adults. Methods: A retrospective cohort study including patients aged 2–18 years admitted to a 24-bed pediatric intensive care unit from 2009 to 2014. Patients were divided into 1 of 3 weight categories: normal weight (body mass index [BMI], 5%–84.9%), overweight (BMI, 85%–94.9%), and obese (BMI ≥95%). Outcomes investigated included mortality, need for intubation, need for inotropic support, and duration of mechanical ventilation. Results: A total of 1817 patient encounters met inclusion criteria. There was no difference in Pediatric Index of Mortality 2 scores between groups. There was a significantly smaller percentage of overweight and obese patients requiring intubation (P =.003) and inotropic support (P =.031) compared with normal-weight patients. Being overweight or obese was neither protective nor a risk factor for mortality with an adjusted odds ratio of 1.83 (confidence interval [CI], 0.82–3.85; P =.12) and 1.51 (CI, 0.70–3.12; P =.27) comparing the overweight and obese groups with the normal-weight group, respectively. There was no difference in duration of mechanical ventilation between the normal-weight and overweight and obese groups (P =.893 and 0.484, respectively). Conclusions: In critically ill pediatric patients, being overweight or obese was associated with decreased need for intubation and inotropic support compared with normal-weight patients. However, being overweight or obese is neither protective nor a risk factor for mortality or duration of mechanical ventilation.