Heated high flow nasal cannula and bilevel positive airway pressure in pediatric asthma exacerbations

Heated High Flow Nasal Cannula (HHFNC) and Bilevel Positive Airway Pressure (BPAP) are noninvasive respiratory support modalities used in pediatric asthma exacerbations. We aim to examine differences in characteristics and outcomes for patients admitted to the Pediatric Intensive Care Unit (PICU) on standard therapy (ST) alone (continuous albuterol and systemic corticosteroids), ST plus HHFNC, and ST plus BPAP.

This is a retrospective and prospective observational cohort study. Chi-Squared/Fisher's exact and Kruskal Wallis tests were used for categorical and continuous outcomes, respectively.

129 patients were included. Younger patients were placed on HHFNC while more severe patients were placed on BPAP. A multiple linear regression controlling for age, sex, race, ethnicity, and exacerbation severity revealed that patients admitted on BPAP had a longer duration of continuous albuterol compared to patients on ST alone (p = 0.02). No differences were found in respiratory support escalation, duration of respiratory support, or adverse events. The BPAP group had the most sedation use and longest length of stay (LOS). Median hourly respiratory rates (RR) increased in the HHFNC group over the first 12 h of admission and remained stable or decreased in the ST and BPAP groups.

This study found that BPAP use in pediatric asthma exacerbations is associated with increased exacerbation severity, longer duration of continuous albuterol, increased sedation use, and longer LOS. Although a multiple linear regression analysis was performed to control for multiple covariates including exacerbation severity, it is possible that intrinsic patient characteristics influenced these outcomes rather than BPAP usage.