---
title: "Obesity Linked to Longer ICU Stays and Greater Ventilatory Support in Pediatric Critical Asthma"
id: "pubmed-42584187"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42584187"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42584187/"
doi: "10.1097/PCC.0000000000004032"
published_at: "2026-08-12T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Obesity Linked to Longer ICU Stays and Greater Ventilatory Support in Pediatric Critical Asthma
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42584187
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42584187/)
- **DOI:** [10.1097/PCC.0000000000004032](https://doi.org/10.1097%2FPCC.0000000000004032)
- **Published At:** 2026-08-12T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This multicenter retrospective cohort study used the Virtual PICU Systems (VPS) database to evaluate the association between **obesity** and intensive care unit (ICU) length of stay in children with critical asthma. - The cohort included 16,412 children aged 2–19 years from 53 centers, admitted to PICUs with a primary diagnosis of asthma between 2010 and 2020, and with available BMI, race, and insurance data. - Patients with chronic medical conditions and those missing relevant data were excluded. - Primary outcome was hazard of ICU discharge among survivors, analyzed as time-to-event (ICU length of stay). - Secondary outcomes assessed use of invasive or noninvasive **mechanical ventilation** within the first hour of ICU admission and after the first hour. - Multivariable Cox and logistic regression models adjusted for age, sex, race, insurance type, pneumonia diagnosis, transfer status, and severity of illness (Pediatric Risk of Mortality III). - Obesity was associated with a lower hazard of ICU discharge (HR 0.87; 95% CI, 0.83–0.91), indicating longer ICU length of stay. - Obesity was associated with higher odds of mechanical ventilation within the first hour (OR 1.24; 95% CI, 1.12–1.39) and after the first hour (OR 1.63; 95% CI, 1.39–1.92). - Associations persisted after adjustment for key confounders. - Race and insurance type did not broadly modify the relationships, but among Black children obesity was not associated with longer ICU length of stay (HR 0.95; 95% CI, 0.89–1.03; p = 0.22). - The authors conclude that **obesity** is independently associated with longer ICU stays and increased respiratory support needs in children with critical asthma, with findings largely consistent across racial and socioeconomic groups. - Conflict of interest: one author (Dr. Bhalla) reported NIH funding sources; other authors disclosed no potential conflicts.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # The Association Between Obesity and ICU Duration in Pediatric Critical Asthma [Tyler C Kingdon](https://pubmed.ncbi.nlm.nih.gov/?term=Kingdon+TC&cauthor_id=42584187)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-1 "Department of Pediatric Cardiology, Rady Children's Hospital and the University of California, San Diego School of Medicine, San Diego, CA."), [Margaret J Klein](https://pubmed.ncbi.nlm.nih.gov/?term=Klein+MJ&cauthor_id=42584187)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-2 "Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA."), [Christopher L Carroll](https://pubmed.ncbi.nlm.nih.gov/?term=Carroll+CL&cauthor_id=42584187)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-3 "AdventHealth for Children, Orlando, FL."), [Benjamin R White](https://pubmed.ncbi.nlm.nih.gov/?term=White+BR&cauthor_id=42584187)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-4 "Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT."), [Jocelyn R Grunwell](https://pubmed.ncbi.nlm.nih.gov/?term=Grunwell+JR&cauthor_id=42584187)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-5 "Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta Arthur M. Blank Children's Hospital, Atlanta, GA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-6 "Department of Pediatrics, Emory University School of Medicine, Atlanta, GA."), [Patrick A Ross](https://pubmed.ncbi.nlm.nih.gov/?term=Ross+PA&cauthor_id=42584187)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-2 "Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-7 "Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA."), [Anoopindar K Bhalla](https://pubmed.ncbi.nlm.nih.gov/?term=Bhalla+AK&cauthor_id=42584187)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-2 "Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#full-view-affiliation-7 "Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.") Affiliations Expand ### Affiliations * 1 Department of Pediatric Cardiology, Rady Children's Hospital and the University of California, San Diego School of Medicine, San Diego, CA. * 2 Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. * 3 AdventHealth for Children, Orlando, FL. * 4 Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT. * 5 Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta Arthur M. Blank Children's Hospital, Atlanta, GA. * 6 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. * 7 Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA. * PMID: **42584187** * DOI: [ 10.1097/PCC.0000000000004032 ](https://doi.org/10.1097/pcc.0000000000004032) Item in Clipboard # The Association Between Obesity and ICU Duration in Pediatric Critical Asthma Tyler C Kingdon et al. Pediatr Crit Care Med. 2026. Show details Display options Display options Format Abstract PubMed PMID Pediatr Crit Care Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Pediatr+Crit+Care+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Pediatr+Crit+Care+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42584187/) . 2026 Aug 12. doi: 10.1097/PCC.0000000000004032. Online ahead of print. ### Authors [Tyler C Kingdon](https://pubmed.ncbi.nlm.nih.gov/?term=Kingdon+TC&cauthor_id=42584187)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-1 "Department of Pediatric Cardiology, Rady Children's Hospital and the University of California, San Diego School of Medicine, San Diego, CA."), [Margaret J Klein](https://pubmed.ncbi.nlm.nih.gov/?term=Klein+MJ&cauthor_id=42584187)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-2 "Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA."), [Christopher L Carroll](https://pubmed.ncbi.nlm.nih.gov/?term=Carroll+CL&cauthor_id=42584187)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-3 "AdventHealth for Children, Orlando, FL."), [Benjamin R White](https://pubmed.ncbi.nlm.nih.gov/?term=White+BR&cauthor_id=42584187)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-4 "Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT."), [Jocelyn R Grunwell](https://pubmed.ncbi.nlm.nih.gov/?term=Grunwell+JR&cauthor_id=42584187)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-5 "Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta Arthur M. Blank Children's Hospital, Atlanta, GA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-6 "Department of Pediatrics, Emory University School of Medicine, Atlanta, GA."), [Patrick A Ross](https://pubmed.ncbi.nlm.nih.gov/?term=Ross+PA&cauthor_id=42584187)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-2 "Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-7 "Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA."), [Anoopindar K Bhalla](https://pubmed.ncbi.nlm.nih.gov/?term=Bhalla+AK&cauthor_id=42584187)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-2 "Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42584187/#short-view-affiliation-7 "Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.") ### Affiliations * 1 Department of Pediatric Cardiology, Rady Children's Hospital and the University of California, San Diego School of Medicine, San Diego, CA. * 2 Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. * 3 AdventHealth for Children, Orlando, FL. * 4 Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT. * 5 Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta Arthur M. Blank Children's Hospital, Atlanta, GA. * 6 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. * 7 Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA. * PMID: **42584187** * DOI: [ 10.1097/PCC.0000000000004032 ](https://doi.org/10.1097/pcc.0000000000004032) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objective:** To evaluate the association between obesity and ICU length of stay (LOS) in children with critical asthma and assess whether socioeconomic factors modify this relationship. **Design:** A multicenter retrospective cohort study using the Virtual PICU Systems (VPS) database of children 2-19 years old admitted to ICUs with asthma between 2010 and 2020. Patients were classified by body mass index (BMI) percentile. Children with chronic medical conditions and those missing relevant data were excluded. Multivariable Cox and logistic regression models were performed and adjusted for confounders. **Setting:** All PICUs in the VPS database. **Patients:** A total of 16,412 children from 53 centers with available data to assign BMI, race, and insurance type were included. **Interventions:** None. **Measurements:** The primary outcome was hazard of ICU discharge among survivors, with ICU LOS as the time-to-event variable. Secondary outcomes included the use of invasive or noninvasive mechanical ventilation (NIV) within the first hour of ICU admission and after the first hour. **Main results:** Obesity was associated with a lower hazard of ICU discharge among survivors (hazard ratio [HR] 0.87 [95% CI, 0.83-0.91]), consistent with longer ICU LOS. Obesity was associated with higher odds of MV in the first hour (odds ratio [OR] 1.24 [95% CI, 1.12-1.39]) and after the first hour (OR 1.63 [95% CI, 1.39-1.92]). These associations remained after adjustment for age, sex, race, insurance type, pneumonia diagnosis, transfer status, and overall severity of illness (Pediatric Risk of Mortality III). Among Black children, obesity was not associated with longer ICU LOS (HR 0.95 [95% CI, 0.89-1.03], p = 0.22). Otherwise, race and insurance type did not significantly modify these associations. **Conclusions:** Obesity is independently associated with longer ICU stays and increased respiratory support in children with critical asthma. These findings are predominantly consistent across racial and socioeconomic groups. **Keywords:** asthma; intensive care unit outcomes; mechanical ventilation; obesity; pediatric critical care. Copyright © 2026 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Dr. Bhalla’s institution received funding from the National Heart, Lung, and Blood Institute; he received support for article research from the National Institutes of Health (R01HL173488 and K23HL153756). The remaining authors have disclosed that they do not have any potential conflicts of interest. ## References 1. 1. Centers for Disease Control and Prevention: National Health Interview Survey 2016-2018. Most Recent National Asthma Data. Last reviewed May 10, 2023. Available at: . Accessed May 14, 2026 2. 1. Ogden CL, Flegal KM. Changes in terminology for childhood overweight and obesity. National health statistics reports; no. 25. National Center for Health Statistics; 2010 3. 1. Ross PA, Newth CJL, Leung D, et al.: Obesity and mortality risk in critically ill children. Pediatrics 2016; 137:e20153904 4. 1. Pournasiri Z, Bakhtiary M, Nikparast A, et al.: The association between nutritional status measured by body mass index and outcomes in the pediatric intensive care unit. Front Pediatr 2024; 12:1421155 5. 1. Peterson LS, Gállego Suárez C, Segaloff HE, et al.: Outcomes and resource use among overweight and obese children with sepsis in the pediatric intensive care unit. J Intensive Care Med 2020; 35:472–477 Show all 37 references [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42584187/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42584187%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42584187/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42584187%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42584187%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42584187/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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