White, Benjamin R.Miller, Andrew G.Baker, JoyceBasnet, SangitaCarroll, Christopher L.Craven, Hannah J.Dalabih, AbdallahFitzpatrick, Anne M.Glogowski, JoelIrazuzta, Jose EnriqueKapuscinski, Christine A.Lenox, JesslynLovinsky-Desir, StephanieMaue, Danielle K.Moody, GeraldNewth, ChristopherRehder, Kyle J.Sochet, Anthony A.Said, Sana J.Willis, L. DeniseWhipple, Elizabeth C.Goodfellow, LyndaAbu-Sultaneh, Samer2025-05-192025-05-192025White BR, Miller AG, Baker J, Basnet S, Carroll CL, Craven H, Dalabih A, Fitzpatrick AM, Glogowski J, Irazuzta JE, Kapuscinski CA, Lenox J, Lovinsky-Desir S, Maue DK, Moody G, Newth C, Rehder KJ, Sochet AA, Said SJ, Willis LD, Whipple EC, Goodfellow L, Abu-Sultaneh S. AARC and PALISI Clinical Practice Guideline: Pediatric Critical Asthma. Respir Care. 2025 May;70(5):593-609. doi: 10.1089/respcare.12897. PMID: 40323974.https://hdl.handle.net/1805/48237To 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: 1. We suggest the use of continuous inhaled short-acting β agonist (SABA) over frequent intermittent SABA in children treated for critical asthma. (Conditional recommendation, very low certainty of evidence) 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) 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) 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) 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) 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) 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) 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) 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) 10. We cannot recommend for or against the application of heliox in children treated for critical asthma. (Conditional recommendation, very low certainty of evidence) 11. We suggest the use of a dedicated protocol or pathway for managing children treated for critical asthma. (Conditional recommendation, low certainty of evidence).en-USInhalation AdministrationAdrenergic beta-AgonistsAnti-Asthmatic AgentsAsthmaPediatricsaminophyllineterbutalinestatus asthmaticusnoninvasive ventilationnoninvasive respiratory supportmagnesiumhigh-flow nasal cannulahelioxglucocorticoidsevidenced-based guidelineclinical practice guidelinechildrenbronchodilatorbi-level positive airway pressureArticle