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Protocols and Pathways in Pediatric Critical Asthma: A Systematic Review and Meta-Analysis.
Danielle K Maue1, L Denise Willis2,3, Jesslyn Lenox4
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
Respiratory Care
|July 11, 2025
Summary
Pediatric asthma treatment protocols shorten hospital and pediatric intensive care unit (PICU) stays. While these protocols reduce the need for escalating respiratory support, they do not impact intubation rates or noninvasive respiratory support (NRS) usage.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Health Services Research
Background:
- Pediatric critical asthma is a frequent cause of emergency department visits and hospital admissions.
- Clinical pathways and protocols are increasingly utilized in respiratory care to improve patient outcomes.
- A systematic review was conducted to evaluate the impact of protocols/pathways in treating pediatric critical asthma.
Purpose of the Study:
- To systematically review the evidence on the effectiveness of clinical pathways and protocols in the management of pediatric critical asthma.
- To assess the impact of these interventions on key clinical outcomes such as length of stay, intubation rates, and respiratory support utilization.
Main Methods:
- A comprehensive search of MEDLINE, Embase, and CINAHL databases was performed without date limitations.
- Included studies comprised randomized controlled trials, crossover studies, observational studies, and quality improvement (QI) studies.
- A fixed-effect meta-analysis was conducted on data extracted from 23 included studies.
Main Results:
- The use of clinical pathways/protocols was associated with a significant reduction in hospital stay (mean difference -0.77 days) and PICU stay (mean difference -0.31 days).
- A decreased incidence of escalating respiratory support was observed (odds ratio 0.59).
- No significant changes were found in intubation rates (odds ratio 0.4) or noninvasive respiratory support (NRS) usage (odds ratio 1.12).
Conclusions:
- Pediatric asthma protocols are linked to shorter hospital and PICU durations.
- These protocols effectively reduce the need for escalating respiratory support.
- Current evidence does not support a significant impact of these protocols on intubation or NRS use in critically ill pediatric asthma patients.
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