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

BACKGROUND: 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. METHODS: 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. RESULTS: 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, p = 0.002; I(2) = 80%), partial pressure of oxygen (MD: 10.61 mmHg, 95% CI: 6.06 to 15.16, p < 0.001; I(2) = 89%), and partial pressure of carbon dioxide (MD: −6.29 mmHg, 95% CI: −9.81 to −2.77, p < 0.001; I(2) = 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, p = 0.007; I(2 )= 71%), improved symptom score (SMD: −1.85, 95% CI: −3.65 to −0.07, p = 0.04; I(2) = 92%), and shortened hospital stay (MD: −1.82 days, 95% CI: −2.32 to −1.31, p < 0.001; I(2 )= 0%). No severe adverse events related to NPPV were reported. CONCLUSIONS: 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.