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Original Article
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- High-flow nasal cannula for respiratory support in children with severe asthma attack: a systematic review and meta-analysis
- Ghea Mangkuliguna, Muhammad Ifan Romli, Adrian Djatikusumo, Nicholas Adrianto
- Acute Crit Care. 2026;41(1):148-159. Published online October 24, 2025
- DOI: https://doi.org/10.4266/acc.003744
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Abstract
PDF - Background
Adjunctive therapies, including high-flow nasal cannula (HFNC) and bilevel positive airway pressure, have been explored to manage severe asthma attacks and avoid invasive ventilation. HFNC has gained interest as a potential alternative. This review evaluated and compared outcomes of HFNC with conventional oxygen therapy or other non-invasive ventilation (NIV) in severe asthma. Methods: A comprehensive search of PubMed/Medline, Scopus, Cochrane Library, and gray literature identified studies published between August 25, 2014, and August 25, 2024. A random-effects meta-analysis was performed, and results were presented in a forest plot. Study quality was assessed using the Cochrane Risk of Bias tool (ROB-2) and Newcastle-Ottawa Scale. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in PROSPERO (CRD42024558656). Results: Nine studies with 14,606 subjects were included. HFNC showed a trend toward improved pulmonary scores, though not statistically significant (P>0.05). Pediatric intensive care unit (PICU) admission and need for escalation of support did not significantly differ from standard oxygen therapy or other NIV. HFNC was associated with a modest but significant increase in readmission (odds ratio, 3.14; 95% CI, 1.07–9.24; P=0.04). PICU length of stay was comparable across groups, and mortality among HFNC-treated patients remained <1%. Overall evidence quality was very low to low. Conclusions: HFNC did not demonstrate superior outcomes over conventional oxygen therapy and other NIV. Evidence remains limited and of low quality, highlighting the need for further high-quality studies. -
Citations
Citations to this article as recorded by
- Respiratory Support in Pediatric Critical and Near-Fatal Asthma: A Narrative Review
Long Xiang, Herng Lee Tan, Andrew Miller, Alexandre T. Rotta, Jan Hau Lee
Pulmonary Therapy.2026;[Epub] CrossRef
- Respiratory Support in Pediatric Critical and Near-Fatal Asthma: A Narrative Review
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