Guideline Video

Guideline Resources

  • Title: Pediatric Critical Asthma
  • Society: American Association for Respiratory Care (AARC)
  • Publish Date: May 5, 2025
  • Guideline Summary
  • Full-text

Video Transcription

Just published May 5th, 2025 - The American Association for Respiratory Care’s newest guideline on Pediatric Critical Asthma. 

The objective of this guideline is to establish a contemporary definition and the first clinical practice guidelines for pediatric critical asthma. 


This guideline was developed using the grade methodology, meaning for each recommendation there will be a strength of recommendation grading as strong or conditional. There will also be certainty of evidence grading as either high, moderate, low, or very low. 

There are 11 recommendations so let’s get started

  • The guideline suggests the use of continuous inhaled short-acting b agonist (SABA) over frequent intermittent SABA in children treated for critical asthma. (Conditional recommendation, very low certainty of evidence)
  • The guidelines suggest the use of either high- or low-dose continuous inhaled SABA regimens in children treated for critical asthma. (Conditional recommendation, very low certainty of evidence)
  • The guideline suggests the use of either dexamethasone or methylprednisolone (or an equivalent dose of prednisone/prednisolone) for children treated for critical asthma. (Conditional recommendation, very low certainty of evidence)
  • The guideline suggests the use of intravenous (IV) magnesium (intermittent or continuous) as an adjunct therapy in children treated for critical asthma. (Conditional recommendation, low certainty of evidence)
  • The guideline cannot recommend for or against the use of IV methylxanthines as an adjunct therapy in children treated for critical asthma. (Conditional recommendation, very low certainty of evidence)
  • The guideline suggests the use of an IV SABA infusion as an adjunct therapy in children treated for critical asthma. (Conditional recommendation, low certainty of evidence)
  • The guideline cannot recommend for or against the application of high-flow nasal cannula versus conventional oxygen therapy in children presenting with critical asthma with persistent hypoxemia and/or respiratory distress. (Conditional recommendation, very low certainty of evidence)
  • The guideline suggests the use of bi-level positive airway pressure over conventional oxygen therapy in children presenting with critical asthma with persistent hypoxemia and/or respiratory distress. (Conditional recommendation, very low certainty of evidence)
  • The guideline cannot recommend for or against the application of bi-level positive airway pressure over highflow nasal cannula for children hospitalized with critical asthma with persistent hypoxemia and/or respiratory distress. (Conditional recommendation, very low certainty of evidence)
  • The guideline cannot recommend for or against the application of heliox in children treated for critical asthma. (Conditional recommendation, very low certainty of evidence)
  • The guideline suggests the use of a dedicated protocol or pathway for managing children treated for critical asthma. (Conditional recommendation, low certainty of evidence)

Make sure to check out the full guideline from the American Association for Respiratory Care and other related clinical decision support tools at guideline central.com.

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