Comparison of the efficacy of high-flow nasal cannula and bi-level positive airway pressure in children with asthma exacerbation: a systematic review and meta-analysis

To compare the effects of high-flow nasal cannula (HFNC) and bi-level positive airway pressure (BiPAP) in the treatment of children with asthma exacerbation. MEDLINE, Embase, CINAHL Complete, China National Knowledge Infrastructure (CNKI), and WanFang databases were systematically searched through 1 December 2024. Studies comparing HFNC and BiPAP in children aged 2–18 years with asthma exacerbation were included. Two reviewers independently screened titles, abstracts, and full texts. Randomized controlled trials (RCTs) and cohort studies reporting clinical or respiratory outcomes were eligible. After screening, a total of 7 studies were included, comprising 374 participants, with 5 randomized controlled trials (RCTs) and 2 retrospective cohort studies. Among the included studies, 5 reported on length of hospital stay, and 4 reported on PICU stay. Both treatment modalities showed no significant impact on hospital stay (MD = −0.24, 95% CI: −1.66, 1.19) or PICU stay (MD = −0.04, 95% CI: −0.82, 0.73). Three studies reported on PaO2, while 2 studies provided data on SaO2, SpO2, and PCO2. Significant heterogeneity was observed across the four indicators, and random-effects models were used for analysis. The results indicated no significant difference in SpO2 and PCO2 between the two treatment groups, but BiPAP significantly improved PaO2 and SaO2 compared to HFNC. Both HFNC and BiPAP can provide adequate ventilatory support for children with asthma exacerbation. However, BiPAP may provide benefits in greater oxygenation (PaO2, SaO2); this effect needs confirmation in future high-quality clinical trials.