Noninvasive and Invasive Ventilation for Asthma Exacerbations in Children

asian child girl patient receiving artificial ventilation in hospital
To address the void in data on ventilation trends among children with asthma, investigators analyzed data from the largest US all-payer database.

The following article is a part of conference coverage from CHEST 2021, being held virtually from October 17 to October 20, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from CHEST 2021.


In children hospitalized due to asthma exacerbations, the use of both non-invasive (NIV) and invasive mechanical ventilation (IMV) is exhibiting an upward trend. This trend is more pronounced with NIV and is associated with significantly higher morbidity and mortality, according to new research presented at the CHEST 2021 Annual Meeting, held virtually October 17 to 20.

The investigators used the largest all-payer database in the United States, the Nationwide Inpatient Sample, to estimate temporal trends of NIV and IMV use, associated outcomes, and predictors in children between 2007 and 2018. The study cohort included patients with pediatric hospitalizations (age ≤18 years) due to asthma exacerbation (International Classification of Diseases 9th/10th Editions Clinical Modification diagnosis codes: ICD-9-CM/ICD-10-CM).

During the study period, there were 1,224,243 hospitalizations due to asthma exacerbation, and ventilation was used in 22,905, for an overall rate of 1.9% (1.4% NIV; 0.5% IMV). Overall ventilation use increased from 0.7% in 2007 to 4.1% in 2018 (P <.001). The researchers attributed this change to a substantial increase in NIV use (from 0.4% in 2007 to 3.5% in 2018; P <.01) and a mild increase in IMV use (from 0.3 in 2007 to 0.6% in 2018; P <.01).

Most patients (90.4%) were less than13 years of age. The cohort was 61.9% male. Of the children studied 34.5% were Black and 33.9% were White. Children who were Black had higher odds of using ventilation (odds ratio [OR], 1.3; 95% CI, 1.2–1.4; P <.01). A greater likelihood of ventilation was also associated with being less than 12 years old, being from the northeast, obesity (OR, 1.9; 95% CI 1.7–2.2; P<.01), weight loss, and anemia.

The researchers also found that IMV use was associated with high odds of in-hospital mortality (OR, 13.9; 95% CI, 11.2–17.3; P <.01) and discharge to facility (OR, 14.3; 95% CI, 11.5–17.8; P <.01) and that NIV was associated only with higher odds of discharge to facilities. Higher in-hospital mortality among children who required ventilation was associated with rural hospitals (OR, 15.9; 95% CI 7.5–33.0; P <.01), nonteaching hospitals, anemia, weight loss, and valvular heart disease.

“Our study highlights the pattern of ventilation utilization and associated outcomes of hospitalizations due to acute asthma exacerbation in [the] pediatric population,” noted the investigators. “Further studies are required to better appreciate factors predisposing [children] to attack severity necessitating ventilatory support.”


Ahmed F, Emmanuel R, Turkmen S, et al. Utilization trends and outcomes of noninvasive and invasive ventilation during asthma exacerbation in children. Presented at: CHEST 2021; October 17-20, 2021; Orlando, FL/Virtual. Abstract A1954-A1955.