Clinical Effectiveness of High-Flow Nasal Cannula and Bilevel Positive Airway Pressure in Children with Critical Asthma - A Systematic Review and Meta-Analysis.

The most common reason for admission to the pediatric intensive care unit (PICU) is asthma. The high-flow nasal cannula (HFNC) and bilevel positive airway pressure (BiPAP) are adjunctive therapies in the treatment of critical asthma. The purpose of this systematic review is to evaluate the clinical effectiveness of HFNC and BiPAP in the treatment of Pediatric critical asthma. Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, Google Scholar, Embase, Lilacs, and ProQuest till September 2025. Bias assessment was done using the JBI risk of bias tool. In STATA version 16, 2019 software, a meta-analysis was conducted using eligible study data, with a 95% confidence interval. The analysis included five studies evaluating the clinical effectiveness of HFNC and BiPAP. A moderate to low risk of bias was demonstrated by the majority of the studies. A statistically significant difference was not observed between the HFNC and BIPAP groups in terms of the length of stay in the PICU (p = 0.48), the length of stay in the hospital (p = 0.13), the rate of escalation, the duration of respiratory support, the level of sedation, or the amount of adjunctive medication needed. There were insufficient data on intubation rates and mortality. Furthermore, there was considerable heterogeneity in the results, and the certainty of the evidence was low overall. Therefore, current evidence remains inconclusive, and well-designed, adequately powered randomized controlled trials are needed for definitive conclusions.