---
title: "HFNC vs BiPAP in Pediatric Critical Asthma: Systematic Review Findings"
id: "pubmed-42766072"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42766072"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42766072/"
doi: "10.1007/s12098-026-06461-w"
published_at: "2026-09-21T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# HFNC vs BiPAP in Pediatric Critical Asthma: Systematic Review Findings
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42766072
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42766072/)
- **DOI:** [10.1007/s12098-026-06461-w](https://doi.org/10.1007%2Fs12098-026-06461-w)
- **Published At:** 2026-09-21T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The review assessed clinical effectiveness of **high-flow nasal cannula (HFNC)** and **bilevel positive airway pressure (BiPAP)** for children with critical asthma admitted to the pediatric intensive care unit (PICU). - Authors followed **PRISMA 2020** and searched PubMed, Scopus, Google Scholar, Embase, Lilacs, and ProQuest through September 2025. - Risk of bias was evaluated using the **JBI risk of bias tool**; most included studies had moderate to low risk of bias. - Meta-analysis was performed in **STATA version 16 (2019)** with results reported at 95% confidence intervals. - Five studies met eligibility criteria and were included in the analysis. - No statistically significant differences were found between HFNC and BiPAP for **PICU length of stay** (p = 0.48) or **hospital length of stay** (p = 0.13). - Other outcomes—rate of escalation of respiratory support, duration of respiratory support, level of sedation, and amount of adjunctive medication—also showed no significant differences between HFNC and BiPAP. - Data on **intubation rates and mortality** were insufficient in the included studies. - Considerable heterogeneity existed across study results, and the overall certainty of evidence was low. - The authors conclude that current evidence is inconclusive and call for well-designed, adequately powered randomized controlled trials to reach definitive conclusions. - Publication details: Jayapriya Thirupathi et al., Indian Journal of Pediatrics, online ahead of print 2026; PMID 42766072; DOI 10.1007/s12098-026-06461-w.
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Online ahead of print. # Clinical Effectiveness of High-Flow Nasal Cannula and Bilevel Positive Airway Pressure in Children with Critical Asthma - A Systematic Review and Meta-Analysis [Jayapriya Thirupathi](https://pubmed.ncbi.nlm.nih.gov/?term=Thirupathi+J&cauthor_id=42766072)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42766072/#full-view-affiliation-1 "Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India."), [Sagar S Kamat](https://pubmed.ncbi.nlm.nih.gov/?term=S+Kamat+S&cauthor_id=42766072)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42766072/#full-view-affiliation-1 "Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India."), [Shubham Verma](https://pubmed.ncbi.nlm.nih.gov/?term=Verma+S&cauthor_id=42766072)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42766072/#full-view-affiliation-1 "Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India."), [Atul Jindal](https://pubmed.ncbi.nlm.nih.gov/?term=Jindal+A&cauthor_id=42766072)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42766072/#full-view-affiliation-2 "Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India. dratuljindal@gmail.com.") Affiliations Expand ### Affiliations * 1 Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India. * 2 Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India. dratuljindal@gmail.com. * PMID: **42766072** * DOI: [ 10.1007/s12098-026-06461-w ](https://doi.org/10.1007/s12098-026-06461-w) Item in Clipboard Review # Clinical Effectiveness of High-Flow Nasal Cannula and Bilevel Positive Airway Pressure in Children with Critical Asthma - A Systematic Review and Meta-Analysis Jayapriya Thirupathi et al. Indian J Pediatr. 2026. Show details Display options Display options Format Abstract PubMed PMID Indian J Pediatr Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Indian+J+Pediatr%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Indian+J+Pediatr%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42766072/) . 2026 Sep 21. doi: 10.1007/s12098-026-06461-w. Online ahead of print. ### Authors [Jayapriya Thirupathi](https://pubmed.ncbi.nlm.nih.gov/?term=Thirupathi+J&cauthor_id=42766072)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42766072/#short-view-affiliation-1 "Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India."), [Sagar S Kamat](https://pubmed.ncbi.nlm.nih.gov/?term=S+Kamat+S&cauthor_id=42766072)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42766072/#short-view-affiliation-1 "Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India."), [Shubham Verma](https://pubmed.ncbi.nlm.nih.gov/?term=Verma+S&cauthor_id=42766072)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42766072/#short-view-affiliation-1 "Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India."), [Atul Jindal](https://pubmed.ncbi.nlm.nih.gov/?term=Jindal+A&cauthor_id=42766072)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42766072/#short-view-affiliation-2 "Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India. dratuljindal@gmail.com.") ### Affiliations * 1 Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India. * 2 Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India. dratuljindal@gmail.com. * PMID: **42766072** * DOI: [ 10.1007/s12098-026-06461-w ](https://doi.org/10.1007/s12098-026-06461-w) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract 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. **Keywords:** Bilevel positive airway pressure; Critical asthma; High-flow nasal cannula; Noninvasive ventilation; Pediatrics. © 2026. The Author(s), under exclusive licence to Dr. K C Chaudhuri Foundation. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflict of Interest: None. ## References 1. 1. White BR, Miller AG, Baker J, et al. AARC and PALISI clinical practice guideline: Pediatric critical asthma. Respir Care. 2025;70:593–609. - [DOI](https://doi.org/10.1089/respcare.12897) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40323974/) 2. 1. Chakrabarti B, Calverley PM. Management of acute ventilatory failure. Postgrad Med J. 2006;82:438–45. - [DOI](https://doi.org/10.1136/pgmj.2005.043208) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/16822920/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/2563765/) 3. 1. Caramez MP, Borges JB, Tucci MR, et al. Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during controlled ventilation. Crit Care Med. 2005;33:1519–28. - [DOI](https://doi.org/10.1097/01.ccm.0000168044.98844.30) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/16003057/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/2287196/) 4. 1. Essouri S, Durand P, Chevret L, et al. Physiological effects of noninvasive positive ventilation during acute moderate hypercapnic respiratory insufficiency in children. Intensive Care Med. 2008;34:2248–55. - [DOI](https://doi.org/10.1007/s00134-008-1202-9) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/18712350/) 5. 1. Pollack CV Jr, Fleisch KB, Dowsey K. Treatment of acute bronchospasm with beta-adrenergic agonist aerosols delivered by a nasal bilevel positive airway pressure circuit. Ann Emerg Med. 1995;26:552–7. - [DOI](https://doi.org/10.1016/s0196-0644\(95\)70003-x) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/7486361/) Show all 27 references ## Publication types * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42766072/) [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42766072/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42766072%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42766072/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42766072%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42766072%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42766072/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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