14/
Management Recommendations:
● Due to elevated risk, it is recommended to monitor closely for early identification of sepsis and management of multiple-organ dysfunction like AKI and cardiorespiratory decompensation, conditions that often prolong the length of ICU stay.

13/
Pathophysiologic effects related to Sepsis:
● A chronic, low-grade, altered inflammatory state, which triggers a massive inflammatory response to an insult

12/
Management Recommendations:
● Close monitoring is needed for early detection of VTE in obese children and adolescents who have comorbidities and coagulation factor deficiencies.

11/
Pathophysiologic effects related to Venous Thromboembolism:
● High risk for thrombus formation with comorbidities and coagulation factor deficiencies

10/
Pathophysiologic effects on the Renal System:
● AKI
Management Recommendations:
● Early recognition of AKI, prevention of fluid overload, appropriate drug dosing for obesity, and avoidance of nephrotoxic drugs are essential to improve outcomes in obese children with AKI.

9/
● Abnormal ECG in obese children necessitates further investigation to identify cardiac anomalies, as ECG changes are infrequent in this population.
● Delivering high-quality CPR is a cornerstone to improve outcomes in obese children with cardiac arrest.

8/
Management Recommendations:
● Subclinical cardiac dysfunction has been documented in obese adolescents with no hypertension.
● Hypertensive crisis in obese children is most likely from secondary causes.

7/
Pathophysiologic effects on Cardiovascular System:
● Elevated total body volume, plasma volume, cardiac output, and venous return -> causing hyperdynamic circulation + heightened intracardiac filling pressures
● Elevated peripheral resistance and left ventricular afterload

6/
● It may be beneficial to extubate on higher PEEP and to administer noninvasive ventilation rather than HFNC after extubation.
● Monitor for postoperative respiratory complications in obese children with OSA

5/
● Anticipate the need for higher tidal volumes to prevent underventilation and higher PEEP to prevent airway collapse over regular settings.
● Higher PEEP trials to prevent airway collapse may be useful

4/
Management Recommendations:
● CPAP or BiPAP may be preferred support over HFNC.
● Plan for difficult-to-bag mask ventilation (2 persons preferred) and difficult airway.
● Ventilator settings: Calculate tidal volumes based on ideal body weight.

3/
Pathophysiologic effects on the Respiratory System:
● Decreased chest wall compliance and pulmonary reserve.
● OSA

2/
Pharmacology Recommendations for sedatives and analgesics:
● It may be better to utilize multiple mini-loading doses to limit adverse effects like respiratory depression.
● Maintenance dosing can be done utilizing lean body weight

7/
Prognosis: Remarkable recoveries are possible – Even profoundly hypothermic patients can survive with appropriate rewarming and critical care. Always resuscitate hypothermic cardiac arrest aggressively in the ICU.