Noninvasive Ventilation in Pediatric Status Asthmaticus is Often Initiated in the ED

Pediatric hospitalization, child in hospital bed
Pediatric hospitalization, child in hospital bed
NIV is sometimes used in the management of refractory pediatric status asthmaticus, but its effectiveness in pediatric asthma is unproven.

Noninvasive ventilation (NIV) is commonly used in the management of pediatric status asthmaticus and is often initiated in the emergency department (ED), according to a study published in the Journal of Asthma.

While NIV is sometimes used in refractory pediatric status asthmaticus for its potential benefits of stenting airways and dispersing albuterol, the study authors wrote, its effectiveness in pediatric asthma remains unproven. Therefore the researchers, from the New York-Presbyterian Morgan Stanley Children’s Hospital and Columbia University Irving Medical Center in New York City, sought to describe the usage pattern of NIV and report the outcomes and safety in pediatric patients with status asthmaticus.

The study included patients 1 year to 21 years of age who were admitted to a tertiary hospital’s pediatric intensive care unit (PICU) with status asthmaticus between January 2016 and December 2018. Children with tracheostomies and baseline NIV were excluded from the study. Using electronic medical records, the researchers extracted information on patients’ medical history, vital signs, imaging, therapy, type of NIV administered, and adverse events.

A total of 101 unique admissions were identified. The patients’ mean age was 7 years. The investigators reported previously diagnosed asthma in 63% of patients and prior PICU admissions in 27%.

They determined that 54% of patients received NIV in the form of bilevel positive airway pressure (BPAP) or continuous positive airway pressure (CPAP), with 20 cases (37%) commencing in the ED. Oxygen saturation at presentation was significantly lower in the NIV vs the non-NIV group (P <.05). Rhinovirus/enterovirus was identified in 82% of the cohort, however, no pneumothoraces, pneumomediastinum, or aspiration pneumonias were documented on available chest radiographs (n=83).

The study authors concluded, “NIV was frequently used, well tolerated, safe, and few patients progressed to mechanical ventilation.” They emphasized that “[f]uture prospective, randomized control trials are urgently needed to determine if NIV affects duration of continuous albuterol, PICU admissions, symptom improvement, and length of stay in moderate to severe pediatric asthma exacerbations.”


Usala C, Wilson P. Noninvasive ventilation use in pediatric status asthmaticus. J Asthma. Published online June 18, 2021. doi:10.1080/02770903.2021.1941085