Institutional Variability in Respiratory Support Use for Pediatric Critical Asthma: A Multicenter Retrospective Study

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Therapy
• Health Services Research

Background:

• Over 20,000 children are hospitalized annually in the US for asthma, highlighting a significant public health concern.
• Existing treatment guidelines for pediatric asthma lack robust evidence on optimal respiratory support devices.
• Variability in respiratory support modality use exists, necessitating an evaluation of influencing factors.

Purpose of the Study:

• To assess institutional and temporal variations in the application of respiratory support modalities for children with critical asthma.
• To identify the impact of hospital volume and admission year on the selection of respiratory support methods.

Main Methods:

• A retrospective cohort study analyzed 77,115 patient encounters from 163 pediatric intensive care units between 2012 and 2021.
• Data from the Virtual Pediatrics Systems database included children over 2 years old with primary asthma or status asthmaticus diagnoses.
• Logistic regression and time-series analyses examined the use of high-flow nasal cannula (HFNC), CPAP, NIV, and IMV in relation to institutional volume and time.

Main Results:

• Significant institutional variability was observed in the use of HFNC, CPAP, NIV, and IMV.
• Higher institutional patient volume correlated with increased use of NIV and CPAP, and decreased use of HFNC and IMV.
• Over the decade, there was a significant increase in the utilization of HFNC, CPAP, and NIV, while IMV use remained stable.

Conclusions:

• Higher-volume pediatric centers are adopting noninvasive positive pressure ventilation more frequently for critical asthma cases.
• There is a trend towards decreased use of HFNC and IMV in higher-volume centers.
• The past decade has seen a notable rise in the application of HFNC, CPAP, and NIV for pediatric critical asthma.