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; David Tellez; Natalie Napolitano; Lauren R. Edwards; Ronald C. Sanders; Taiki Kojima; Matthew P. Malone; Justine Shults; Conrad Krawiec; Shashikanth Ambati; Riley McCarthy; Aline Branca; Lee A. Polikoff; Philipp Jung; Simon J. Parsons; Palen P. Mallory; Kavipriya Komeswaran; Christopher Page-Goertz; Megan C. Toal; G. Kris Bysani; Keith Meyer; Fabrizio Chiusolo; Lily B. Glater-Welt; Awni Al-Subu; Katherine Biagas; Jan Hau Lee; Michael Miksa; John S. Giuliano; Krista L. Kierys; Andrea M. Talukdar; Michelle Derusso; Laurence Cucharme-Crevier; Michelle Adu-Arko; Asha N. Shenoi; Dai Kimura; Molly Flottman; Shantaveer Gangu; Ashley D. Freeman; Mark D. Piehl; G. A. Nuthall; Keiko M. Tarquinio; Ilana Harwayne-Gidansky; Tatsuya Hasegawa; Erin S. Rescoe; Ryan K. Breuer; Mioko Kasagi; Vinay M. Nadkarni; Akira Nishisaki; 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

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, David Tellez, Natalie Napolitano, Lauren R. Edwards, Ronald C. Sanders, Taiki Kojima, Matthew P. Malone, Justine Shults, Conrad Krawiec, Shashikanth Ambati, Riley McCarthy, Aline Branca, Lee A. Polikoff, Philipp Jung, Simon J. Parsons, Palen P. Mallory, Kavipriya Komeswaran, Christopher Page-Goertz, Megan C. Toal, G. Kris BysaniKeith Meyer, Fabrizio Chiusolo, Lily B. Glater-Welt, Awni Al-Subu, Katherine Biagas, Jan Hau Lee, Michael Miksa, John S. Giuliano, Krista L. Kierys, Andrea M. Talukdar, Michelle Derusso, Laurence Cucharme-Crevier, Michelle Adu-Arko, Asha N. Shenoi, Dai Kimura, Molly Flottman, Shantaveer Gangu, Ashley D. Freeman, Mark D. Piehl, G. A. Nuthall, Keiko M. Tarquinio, Ilana Harwayne-Gidansky, Tatsuya Hasegawa, Erin S. Rescoe, Ryan K. Breuer, Mioko Kasagi, Vinay M. Nadkarni, Akira Nishisaki, 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

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Pages (from-to)	147-158
Number of pages	12
Journal	Pediatric Critical Care Medicine
Volume	25
Issue number	2
DOIs	https://doi.org/10.1097/PCC.0000000000003387
State	Published - Feb 1 2024
Externally published	Yes

Keywords

body weight
hypoxia
intubation
obesity
pediatrics

ASJC Scopus subject areas

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1097/PCC.0000000000003387

Cite this

Gladen, K. M., Tellez, D., Napolitano, N., Edwards, L. R., Sanders, R. C., Kojima, T., Malone, M. P., Shults, J., Krawiec, C., Ambati, S., McCarthy, R., Branca, A., Polikoff, L. A., Jung, P., Parsons, S. J., Mallory, P. P., Komeswaran, K., Page-Goertz, C., Toal, M. C., ... Buffman, H. (2024). Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020). Pediatric Critical Care Medicine, 25(2), 147-158. https://doi.org/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). / Gladen, Kelsey M.; Tellez, David; Napolitano, Natalie et al.
In: Pediatric Critical Care Medicine, Vol. 25, No. 2, 01.02.2024, p. 147-158.

Research output: Contribution to journal › Article › peer-review

Gladen, KM, Tellez, D, Napolitano, N, Edwards, LR, Sanders, RC, Kojima, T, Malone, MP, Shults, J, Krawiec, C, Ambati, S, McCarthy, R, Branca, A, Polikoff, LA, Jung, P, Parsons, SJ, Mallory, PP, Komeswaran, K, Page-Goertz, C, Toal, MC, Bysani, GK, Meyer, K, Chiusolo, F, Glater-Welt, LB, Al-Subu, A, Biagas, K, Hau Lee, J, Miksa, M, Giuliano, JS, Kierys, KL, Talukdar, AM, Derusso, M, Cucharme-Crevier, L, Adu-Arko, M, Shenoi, AN, Kimura, D, Flottman, M, Gangu, S, Freeman, AD, Piehl, MD, Nuthall, GA, Tarquinio, KM, Harwayne-Gidansky, I, Hasegawa, T, Rescoe, ES, Breuer, RK, Kasagi, M, Nadkarni, VM, Nishisaki, A, Flori, H, Thomas, N, Agus, M, Dahmer, M, Goertzen, L, Khemani, R, Pinto, N, Faustino, V, Brown, AM, Prieto, M, Wing, R & Buffman, H 2024, 'Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020)', Pediatric Critical Care Medicine, vol. 25, no. 2, pp. 147-158. https://doi.org/10.1097/PCC.0000000000003387

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

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.",

keywords = "body weight, hypoxia, intubation, obesity, pediatrics",

author = "Gladen, {Kelsey M.} and David Tellez and Natalie Napolitano and Edwards, {Lauren R.} and Sanders, {Ronald C.} and Taiki Kojima and Malone, {Matthew P.} and Justine Shults and Conrad Krawiec and Shashikanth Ambati and Riley McCarthy and Aline Branca and Polikoff, {Lee A.} and Philipp Jung and Parsons, {Simon J.} and Mallory, {Palen P.} and Kavipriya Komeswaran and Christopher Page-Goertz and Toal, {Megan C.} and Bysani, {G. Kris} and Keith Meyer and Fabrizio Chiusolo and Glater-Welt, {Lily B.} and Awni Al-Subu and Katherine Biagas and {Hau Lee}, Jan and Michael Miksa and Giuliano, {John S.} and Kierys, {Krista L.} and Talukdar, {Andrea M.} and Michelle Derusso and Laurence Cucharme-Crevier and Michelle Adu-Arko and Shenoi, {Asha N.} and Dai Kimura and Molly Flottman and Shantaveer Gangu and Freeman, {Ashley D.} and Piehl, {Mark D.} and Nuthall, {G. A.} and Tarquinio, {Keiko M.} and Ilana Harwayne-Gidansky and Tatsuya Hasegawa and Rescoe, {Erin S.} and Breuer, {Ryan K.} and Mioko Kasagi and Nadkarni, {Vinay M.} and Akira Nishisaki and Heidi Flori and Neal Thomas and Michael Agus and Mary Dahmer and Lexie Goertzen and Robinder Khemani and Neethi Pinto and Vincent Faustino and Brown, {Ann Marie} and Monica Prieto and Robyn Wing and Hayley Buffman",

year = "2024",

month = feb,

day = "1",

doi = "10.1097/PCC.0000000000003387",

language = "English (US)",

volume = "25",

pages = "147--158",

journal = "Pediatric Critical Care Medicine",

issn = "1529-7535",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children

T2 - Retrospective Study of the National Emergency Airway for Children Registry (2013-2020)

AU - Gladen, Kelsey M.

AU - Tellez, David

AU - Napolitano, Natalie

AU - Edwards, Lauren R.

AU - Sanders, Ronald C.

AU - Kojima, Taiki

AU - Malone, Matthew P.

AU - Shults, Justine

AU - Krawiec, Conrad

AU - Ambati, Shashikanth

AU - McCarthy, Riley

AU - Branca, Aline

AU - Polikoff, Lee A.

AU - Jung, Philipp

AU - Parsons, Simon J.

AU - Mallory, Palen P.

AU - Komeswaran, Kavipriya

AU - Page-Goertz, Christopher

AU - Toal, Megan C.

AU - Bysani, G. Kris

AU - Meyer, Keith

AU - Chiusolo, Fabrizio

AU - Glater-Welt, Lily B.

AU - Al-Subu, Awni

AU - Biagas, Katherine

AU - Hau Lee, Jan

AU - Miksa, Michael

AU - Giuliano, John S.

AU - Kierys, Krista L.

AU - Talukdar, Andrea M.

AU - Derusso, Michelle

AU - Cucharme-Crevier, Laurence

AU - Adu-Arko, Michelle

AU - Shenoi, Asha N.

AU - Kimura, Dai

AU - Flottman, Molly

AU - Gangu, Shantaveer

AU - Freeman, Ashley D.

AU - Piehl, Mark D.

AU - Nuthall, G. A.

AU - Tarquinio, Keiko M.

AU - Harwayne-Gidansky, Ilana

AU - Hasegawa, Tatsuya

AU - Rescoe, Erin S.

AU - Breuer, Ryan K.

AU - Kasagi, Mioko

AU - Nadkarni, Vinay M.

AU - Nishisaki, Akira

AU - Flori, Heidi

AU - Thomas, Neal

AU - Agus, Michael

AU - Dahmer, Mary

AU - Goertzen, Lexie

AU - Khemani, Robinder

AU - Pinto, Neethi

AU - Faustino, Vincent

AU - Brown, Ann Marie

AU - Prieto, Monica

AU - Wing, Robyn

AU - Buffman, Hayley

PY - 2024/2/1

Y1 - 2024/2/1

N2 - 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.

AB - 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.

KW - body weight

KW - hypoxia

KW - intubation

KW - obesity

KW - pediatrics

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ER -

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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