(1198) High-Flow Nasal Cannula Versus Bilevel Positive Airway Pressure in Pediatric Asthma Exacerbations

Introduction: High flow nasal cannula (HFNC) and Bilevel Positive Airway Pressure (BPAP) are respiratory support modalities used in pediatric asthma exacerbations to deliver beta agonist and improve respiratory mechanics. We aim to assess differences in characteristics and outcomes in patients admitted to the Pediatric Intensive Care Unit (PICU) with an asthma exacerbation on standard therapy (ST) alone (continuous beta agonist and systemic corticosteroids), ST plus HFNC, and ST plus BPAP.

Methods: This observational cohort study examined children aged 3-17 admitted to the PICU with an asthma exacerbation on continuous beta agonist therapy between 9/01/2019 - 9/01/2022. Patients were identified using Virtual Pediatric Systems and screened for ICD 10 codes that included “asthma”. Eligible patients were divided into 3 groups based on their initial respiratory support: ST group, ST plus HFNC, and ST plus BPAP. Demographic data was recorded. The primary outcome assessed the duration of continuous beta agonist therapy. Secondary outcomes included escalation of initial respiratory support, duration of respiratory support, use of adjunct asthma therapies, sedation, adverse events, PICU and hospital length of stay (LOS).

Results: 129 patients met inclusion criteria (ST n=57, HFNC n= 17, BPAP n=55). No significant differences were found in baseline demographics. Patients on BPAP had significantly longer duration of continuous beta agonist therapy (median=24.5 hrs, IQR=15.4-45.6) compared with ST (median=18.9 hrs, IQR 6.8-21.1; p=0.0008) and HFNC (median=11.9 hrs, IQR=9.7-22.8; p=0.04). No significant differences were found in need for escalation of respiratory support, duration of respiratory support, and adverse events. Patients on HFNC were least likely to require adjunct asthma medications (p=0.0046). Sedation was most common in the BPAP group (p=0.0344). The BPAP group had significantly longer PICU LOS (median=43.4 hrs, IQR 22.0-62.1) compared to ST (p=0.005) and HFNC (p=0.03). Finally, the BPAP group had a longer hospital LOS relative to the ST group (p=0.005).

Conclusions: The use of BPAP during pediatric asthma exacerbations is associated with longer duration of continuous beta agonist use, increased sedation use, and longer PICU and hospital LOS compared with patients on ST and HFNC.