Impact of Weight Extremes on Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome.

Objectives: To determine whether weight extremes impact clinical outcomes in pediatric acute respiratory distress syndrome. Design: Post hoc analysis of a cohort created by combining five multicenter pediatric acute respiratory distress syndrome studies. Setting: Forty-three academic PICUs worldwide. Patients: A total of 711 subjects prospectively diagnosed with pediatric acute respiratory distress syndrome. Intervention: Subjects more than 2 years were included and categorized by Center for Disease Control and Prevention body mass index z score criteria: underweight (= +1.65). Subjects were stratified by direct versus indirect lung injury leading to pediatric acute respiratory distress syndrome. The primary outcome was in-hospital mortality. In survivors, secondary analyses included duration of mechanical ventilation and ICU length of stay. Measurements and Main Results: A total of 331 patients met inclusion criteria; 12% were underweight, 50% normal weight, 11% overweight, and 27% obese. Overall mortality was 20%. By multivariate analysis, body mass index category was independently associated with mortality (p = 0.004). When stratified by lung injury type, there was no mortality difference between body mass index groups with direct lung injury; however, in the indirect lung injury group, the odds of mortality in the obese were significantly lower than normal weight subjects (odds ratio, 0.11; 95% CI, 0.02-0.84). Survivors with direct lung injury had no difference in the duration of mechanical ventilation or ICU length of stay; however, those with indirect lung injury, the overweight required longer duration of mechanical ventilation than other groups (p

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