Changes in the Use of Invasive and Noninvasive Mechanical Ventilation in Pediatric Asthma: 2009–2019

Abstract

Rationale: Despite lower overall hospitalization rates for asthma in recent years, there has been an increase in the number of pediatric patients receiving intensive care management in the United States.Objectives: To investigate how the use of invasive and noninvasive mechanical ventilation for asthma has changed in the context of an evolving cohort of critically ill pediatric patients with asthma.Methods: We analyzed children admitted to intensive care units for asthma from 2009 through 2019 in the Virtual Pediatric Systems database. Regression analyses were used to evaluate how respiratory support interventions, mortality, and patient characteristics have changed over time. Odds ratios were calculated to determine how patient characteristics were associated with respiratory support needs. Stratified analyses were performed to determine how changing practice patterns may have differed between patient subgroups.Results: There were 67,614 admissions for 56,727 patients analyzed. Intubation occurred in 4.6% of admissions and decreased from 6.9% to 3.4% over time (P , 0.001), whereas noninvasive ventilation as the maximal respiratory support increased from 8.9% to 20.0% (P , 0.001). Over time, the cohort shifted to include more 2-to 6-year-olds and patients of Asian/Pacific Islander or Hispanic race/ethnicity. Although intubation decreased and noninvasive ventilation increased in all subgroups, the changes were most pronounced in the youngest patients and slightly less pronounced for obese patients.Conclusions: In pediatric asthma, use of intubation has halved, whereas use of noninvasive ventilation has more than doubled. This change in practice appears partially related to a younger patient cohort, although other factors merit exploration.

Outcomes of a respiratory therapist driven high flow nasal cannula management protocol for pediatric critical asthma patients

“…Finally, our protocol did not include a standardized criteria to start HFNC. Given the national trend of trading conventional oxygen therapy via facemask with HFNC in pediatric critical asthma, 43 future interventions can aim to standardize the HFNC initiation in emergency rooms and PICUs.…”

High‐flow nasal cannula in critical asthma: Time for the respiratory therapists to drive care!

“…16 Despite the lack of high-quality evidence, HFNC is now ubiquitous to PICUs and its frequency of use in children with critical asthma is increasing. 5,17 In this issue of Pediatric Pulmonology, Maue et al 18 used standard quality improvement (QI) methodology combined with multivariable linear regression to evaluate the effect of adding a respiratory therapist (RT)-driven HFNC weaning protocol to their existing continuous albuterol weaning pathway for children with critical asthma. 19 The primary outcome was duration of HFNC therapy.…”

“…However, one study 14 reported an association between HFNC use and a delay in initiating noninvasive ventilation (NIV) and a recent propensity‐scored matched study using an administrative database noted HFNC use was associated with longer hospital length of stay 16 . Despite the lack of high‐quality evidence, HFNC is now ubiquitous to PICUs and its frequency of use in children with critical asthma is increasing 5,17 …”