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Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU.
Crit Care Med. 2016 Aug; 44(8):1530-7.CC

Abstract

OBJECTIVE

To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU.

DESIGN

Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis.

SETTING

Ninety PICUs from 16 countries with eight or more beds.

PATIENTS

Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours.

MEASUREMENTS AND MAIN RESULTS

Data from 1,622 eligible patients, 54.8% men and mean (SD) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively.

CONCLUSIONS

Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.

Authors+Show Affiliations

1Center for Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2Department of Nutritional Sciences, Rutgers University School of Health Related Professions, Newark, NJ. 3Department of Interdisciplinary Studies, Rutgers University School of Health Related Professions, Newark, NJ. 4Clinical Evaluation Research Unit, Kingston General Hospital and Queen's University, Kingston, ON, Canada. 5Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

26985636

Citation

Bechard, Lori J., et al. "Nutritional Status Based On Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU." Critical Care Medicine, vol. 44, no. 8, 2016, pp. 1530-7.
Bechard LJ, Duggan C, Touger-Decker R, et al. Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU. Crit Care Med. 2016;44(8):1530-7.
Bechard, L. J., Duggan, C., Touger-Decker, R., Parrott, J. S., Rothpletz-Puglia, P., Byham-Gray, L., Heyland, D., & Mehta, N. M. (2016). Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU. Critical Care Medicine, 44(8), 1530-7. https://doi.org/10.1097/CCM.0000000000001713
Bechard LJ, et al. Nutritional Status Based On Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU. Crit Care Med. 2016;44(8):1530-7. PubMed PMID: 26985636.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU. AU - Bechard,Lori J, AU - Duggan,Christopher, AU - Touger-Decker,Riva, AU - Parrott,J Scott, AU - Rothpletz-Puglia,Pamela, AU - Byham-Gray,Laura, AU - Heyland,Daren, AU - Mehta,Nilesh M, PY - 2016/3/18/entrez PY - 2016/3/18/pubmed PY - 2017/5/31/medline SP - 1530 EP - 7 JF - Critical care medicine JO - Crit Care Med VL - 44 IS - 8 N2 - OBJECTIVE: To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU. DESIGN: Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis. SETTING: Ninety PICUs from 16 countries with eight or more beds. PATIENTS: Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours. MEASUREMENTS AND MAIN RESULTS: Data from 1,622 eligible patients, 54.8% men and mean (SD) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively. CONCLUSIONS: Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/26985636/Nutritional_Status_Based_on_Body_Mass_Index_Is_Associated_With_Morbidity_and_Mortality_in_Mechanically_Ventilated_Critically_Ill_Children_in_the_PICU_ L2 - https://dx.doi.org/10.1097/CCM.0000000000001713 DB - PRIME DP - Unbound Medicine ER -