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Vascular Access in Critically Ill Pediatric Patients With Obesity
Elizabeth E Halvorson1, Doug Case2, Joseph A Skelton1,3
1Department of Pediatrics, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC.
Insights
Critically ill children with severe obesity had fewer vascular access devices placed but a higher risk of complications. Obesity increases the likelihood of peripherally inserted central catheter placement and related issues.
Area of Science:
- Pediatric critical care medicine
- Vascular access
- Obesity in children
Background:
- Pediatric obesity is a growing public health concern.
- Obesity is linked to poorer outcomes in hospitalized children.
- Vascular access is crucial for managing critically ill pediatric patients.
Purpose of the Study:
- To investigate the association between obesity and vascular access device (VAD) placement in critically ill children.
- To determine if critically ill children with obesity have a higher incidence of VAD-related complications.
Main Methods:
- Multi-institutional retrospective observational cohort study.
- Analysis of 120,272 pediatric patients (2-17 years) from 94 U.S. PICUs (2009-2014).
- Used multivariable logistic regression to assess BMI category as a predictor of VAD placement and complications.
Main Results:
- Obese children (all classes) were less likely to receive any VAD (OR 0.74 for class 3 obesity).
- Obese children were more likely to receive peripherally inserted central catheters (PICCs), especially class 2 (OR 1.26).
- Class 1 and class 3 obesity were independent risk factors for VAD complications (ORs 1.31 and 1.45, respectively).
Conclusions:
- Severe obesity is associated with reduced overall vascular access device placement in critically ill children.
- Obesity increases the likelihood of PICC line placement and associated complications.
- Vascular access strategies and complication monitoring should consider obesity in critically ill children.
Objectives:
Pediatric obesity is highly prevalent and has been associated with poor outcomes for hospitalized children. Vascular access is essential in critically ill patients. The aim of this study was to evaluate whether critically ill children with obesity are more likely to undergo vascular device insertion (excluding peripheral IV catheters) and develop related complications.
Design:
Multi-institutional retrospective observational cohort study.
Setting:
Ninety-four U.S. PICUs included in the Virtual Pediatric Systems, LLC database.
Patients:
120,272 unique patients 2 to less than 18 years old admitted between January 2009 and December 2014.
Interventions:
None.
Measurements And Main Results:
Patients were categorized into normal weight, overweight, and obese (class 1, 2, or 3); underweight patients were excluded. We used mixed-effects multivariable logistic regression to test body mass index category as an independent predictor of vascular device placement and associated complications, adjusted for age, sex, severity of illness, primary diagnosis, presence of a complex chronic condition, and admission related to trauma or surgery. A total of 73,964 devices were placed in 45,409 patients (37.8% of the total cohort received a vascular device). Most device types placed differed significantly by weight status. Subjects with class 3 obesity were less likely (odds ratio, 0.74; 95% CI, 0.67-0.81) to undergo placement of any device compared with normal weight patients. Patients with all classes of obesity were more likely to undergo placement of a peripherally inserted central catheter, with the strongest association in those with class 2 obesity (odds ratio, 1.26; 95% CI, 1.14-1.40). Class 1 and class 3 obesity were independent risk factors for developing a complication, with odds ratio of 1.31 (95% CI, 1.11-1.53) and 1.45 (95% CI, 1.07-1.99), respectively.
Conclusions:
Severe obesity is associated with decreased overall likelihood of placement of a vascular access device but increased likelihood of peripherally inserted central catheter placement and of device-related complications.
