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The Association Between Obesity and ICU Duration in Pediatric Critical Asthma

Tyler C Kingdon1, Margaret J Klein2, Christopher L Carroll3

  • 1Department of Pediatric Cardiology, Rady Children's Hospital and the University of California, San Diego School of Medicine, San Diego, CA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|August 12, 2026
PubMed

Insights

Obesity in children with critical asthma is linked to longer intensive care unit (ICU) stays and increased need for respiratory support. These associations were generally consistent across different racial and socioeconomic backgrounds.

Area of Science:

  • Pediatric critical care medicine
  • Asthma management
  • Obesity research

Background:

  • Obesity is a growing concern in pediatric populations.
  • The impact of obesity on outcomes for children with critical asthma admitted to the intensive care unit (ICU) is not fully understood.
  • Socioeconomic factors may influence healthcare disparities and outcomes.

Purpose of the Study:

  • To investigate the association between obesity and ICU length of stay (LOS) in children with critical asthma.
  • To determine if socioeconomic factors, such as race and insurance type, modify the relationship between obesity and ICU outcomes.

Main Methods:

  • A multicenter retrospective cohort study utilized the Virtual PICU Systems (VPS) database from 2010-2020.
  • Included were 16,412 children aged 2-19 years admitted to ICUs with asthma, classified by body mass index (BMI) percentile.
  • Multivariable regression models were employed to analyze the primary outcome of ICU discharge hazard and secondary outcomes including mechanical ventilation (MV).

Main Results:

  • Obesity was associated with a longer ICU LOS (lower discharge hazard ratio: 0.87) and increased odds of requiring mechanical ventilation (MV) both within the first hour (OR 1.24) and after the first hour (OR 1.63).
  • These associations persisted after adjusting for confounders like age, sex, race, insurance, and illness severity.
  • While obesity was not significantly associated with longer ICU LOS in Black children (HR 0.95), race and insurance type did not generally modify the primary associations.

Conclusions:

  • Obesity is an independent risk factor for prolonged ICU stays and increased need for respiratory support in pediatric patients with severe asthma.
  • The findings suggest that the negative impact of obesity on ICU outcomes for children with asthma is largely consistent across diverse racial and socioeconomic groups.
Abstract

Keywords:
asthmaintensive care unit outcomesmechanical ventilationobesitypediatric critical care

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