AUTHOR=Dai Jiajia , Wang Libo , Wang Fang , Wang Lu , Wen Qingfen 

TITLE=Noninvasive positive-pressure ventilation for children with acute asthma: a meta-analysis of randomized controlled trials

JOURNAL=Frontiers in Pediatrics

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1167506

DOI=10.3389/fped.2023.1167506

ISSN=2296-2360

ABSTRACT=<sec><title>Background</title><p>Noninvasive positive-pressure ventilation (NPPV) can be effective in children with acute asthma. However, clinical evidence remains limited. The objective of the meta-analysis was to systematically assess NPPV's effectiveness and safety in treating children with acute asthma.</p></sec><sec><title>Methods</title><p>Relevant randomized controlled trials were obtained from electronic resources, including PubMed, Embase, Cochrane's Library, Wanfang, and CNKI databases. The influence of potential heterogeneity was taken into account before using a random-effect model to pool the results.</p></sec><sec><title>Results</title><p>A total of 10 RCTs involving 558 children with acute asthma were included in the meta-analysis. Compared to conventional treatment alone, additional use of NPPV significantly improved early blood gas parameters such as the oxygen saturation (mean difference [MD]: 4.28%, 95% confidence interval [CI]: 1.51 to 7.04, <italic>p </italic>= 0.002; <italic>I</italic><sup>2</sup> = 80%), partial pressure of oxygen (MD: 10.61 mmHg, 95% CI: 6.06 to 15.16, <italic>p </italic>&lt; 0.001; <italic>I</italic><sup>2</sup> = 89%), and partial pressure of carbon dioxide (MD: −6.29 mmHg, 95% CI: −9.81 to −2.77, <italic>p </italic>&lt; 0.001; <italic>I</italic><sup>2</sup> = 85%) in the arterial blood. Moreover, NPPV was also associated with early reduced respiratory rate (MD: −12.90, 95% CI: −22.21 to −3.60, <italic>p </italic>= 0.007; <italic>I</italic><sup>2 </sup>= 71%), improved symptom score (SMD: −1.85, 95% CI: −3.65 to −0.07, <italic>p </italic>= 0.04; <italic>I</italic><sup>2</sup> = 92%), and shortened hospital stay (MD: −1.82 days, 95% CI: −2.32 to −1.31, <italic>p </italic>&lt; 0.001; <italic>I</italic><sup>2 </sup>= 0%). No severe adverse events related to NPPV were reported.</p></sec><sec><title>Conclusions</title><p>NPPV in children with acute asthma is associated with improved gas exchange, decreased respiratory rates, a lower symptom score, and a shorter hospital stay. These results suggest that NPPV may be as effective and safe as conventional treatment for pediatric patients with acute asthma.</p></sec>