{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:20:59Z","timestamp":1792135259663,"version":"4.4.0"},"reference-count":132,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>To address the lack of guidance for clinicians in their care of children with critical asthma, a multidisciplinary team of medical providers used Grading of Recommendations, Assessment, Development, and Evaluation methodology to make the following recommendations:<\/jats:p>\n                  <jats:p>1. We suggest the use of continuous inhaled short-acting \u03b2 agonist (SABA) over frequent intermittent SABA in children treated for critical asthma. (Conditional recommendation, very low certainty of evidence)<\/jats:p>\n                  <jats:p>2. We 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)<\/jats:p>\n                  <jats:p>3. We suggest 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)<\/jats:p>\n                  <jats:p>4. We suggest 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)<\/jats:p>\n                  <jats:p>5. We 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)<\/jats:p>\n                  <jats:p>6. We suggest the use of an IV SABA infusion as an adjunct therapy in children treated for critical asthma. (Conditional recommendation, low certainty of evidence)<\/jats:p>\n                  <jats:p>7. We 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)<\/jats:p>\n                  <jats:p>8. We suggest 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)<\/jats:p>\n                  <jats:p>9. We cannot recommend for or against the application of bi-level positive airway pressure over high-flow nasal cannula for children hospitalized with critical asthma with persistent hypoxemia and\/or respiratory distress. (Conditional recommendation, very low certainty of evidence)<\/jats:p>\n                  <jats:p>10. We cannot recommend for or against the application of heliox in children treated for critical asthma. (Conditional recommendation, very low certainty of evidence)<\/jats:p>\n                  <jats:p>11. We suggest the use of a dedicated protocol or pathway for managing children treated for critical asthma. (Conditional recommendation, low certainty of evidence)<\/jats:p>","DOI":"10.1089\/respcare.12897","type":"journal-article","created":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T13:38:46Z","timestamp":1746452326000},"page":"593-609","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["AARC and PALISI Clinical Practice Guideline: Pediatric Critical Asthma"],"prefix":"10.1177","volume":"70","author":[{"given":"Benjamin R.","family":"White","sequence":"first","affiliation":[{"name":"Dr. White is affiliated with Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, Utah, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G.","family":"Miller","sequence":"additional","affiliation":[{"name":"Mr. Miller and Dr. Rehder are affiliated with Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA."},{"name":"Mr. Miller is affiliated with Respiratory Care Services, Duke University Medical Center, Durham, North Carolina, USA."},{"name":"Mr. Miller is affiliated with Thomas Jefferson University, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Baker","sequence":"additional","affiliation":[{"name":"Mrs. Baker is affiliated with Breathing Institute, Children\u2019s Hospital Colorado Aurora, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangita","family":"Basnet","sequence":"additional","affiliation":[{"name":"Dr. Basnet is affiliated with Division of Pediatric Critical Care Medicine, Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L.","family":"Carroll","sequence":"additional","affiliation":[{"name":"Drs. Carroll and Irazuzta are affiliated with Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, University of Florida, Jacksonville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1701-3655","authenticated-orcid":false,"given":"Hannah","family":"Craven","sequence":"additional","affiliation":[{"name":"Ms. Craven and Ms. Whipple are affiliated with Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1198-1129","authenticated-orcid":false,"given":"Abdallah","family":"Dalabih","sequence":"additional","affiliation":[{"name":"Dr. Dalabih is affiliated with Driscoll Children\u2019s Health System, Corpus Christi, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Dr. Fitzpatrick is affiliated with Division of Pulmonology, Emory University, Atlanta, Georgia, USA."},{"name":"Dr. Fitzpatrick is affiliated with Department of Pediatrics, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Glogowski","sequence":"additional","affiliation":[{"name":"Mr. Glogowski is affiliated with Georgia State University Library, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Enrique","family":"Irazuzta","sequence":"additional","affiliation":[{"name":"Drs. Carroll and Irazuzta are affiliated with Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, University of Florida, Jacksonville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine A.","family":"Kapuscinski","sequence":"additional","affiliation":[{"name":"Dr. Kapuscinski is affiliated with Department of Pharmacy, John R. Oishei Children\u2019s Hospital, Buffalo, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesslyn","family":"Lenox","sequence":"additional","affiliation":[{"name":"Ms. Lenox is affiliated with Respiratory Care Services, South Shore Health System, South Weymouth, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Lovinsky-Desir","sequence":"additional","affiliation":[{"name":"Dr. Lovinsky-Desir is affiliated with Departments of Pediatrics and Environmental Health Sciences, Columbia University Medical Center, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle K.","family":"Maue","sequence":"additional","affiliation":[{"name":"Dr. Maue is affiliated with Division of Pediatric Critical Care Medicine, Cincinnati Children\u2019s Hospital, Cincinnati, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Moody","sequence":"additional","affiliation":[{"name":"Mr. Moody is affiliated with Department of Respiratory Care, Children\u2019s Health \u2013 Children\u2019s Medical Center, Plano, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Newth","sequence":"additional","affiliation":[{"name":"Dr. Newth is affiliated with Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children\u2019s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle J.","family":"Rehder","sequence":"additional","affiliation":[{"name":"Mr. Miller and Dr. Rehder are affiliated with Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony A.","family":"Sochet","sequence":"additional","affiliation":[{"name":"Dr. Sochet is affiliated with Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana J.","family":"Said","sequence":"additional","affiliation":[{"name":"Dr. Said is affiliated with Department of Pharmacy, Comer Children\u2019s Hospital, University of Chicago Medicine, Chicago, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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