BackgroundNoninvasive positive-pressure ventilation (NPPV) can be effective in children with acute asthma. However, clinical evidence remains limited. The objective of the meta-analysis was to systematically assess NPPV's effectiveness and safety in treating children with acute asthma.MethodsRelevant randomized controlled trials were obtained from electronic resources, including PubMed, Embase, Cochrane's Library, Wanfang, and CNKI databases. The influence of potential heterogeneity was taken into account before using a random-effect model to pool the results.ResultsA total of 10 RCTs involving 558 children with acute asthma were included in the meta-analysis. Compared to conventional treatment alone, additional use of NPPV significantly improved early blood gas parameters such as the oxygen saturation (mean difference [MD]: 4.28%, 95% confidence interval [CI]: 1.51 to 7.04,p= 0.002;I2= 80%), partial pressure of oxygen (MD: 10.61 mmHg, 95% CI: 6.06 to 15.16,p< 0.001;I2= 89%), and partial pressure of carbon dioxide (MD: −6.29 mmHg, 95% CI: −9.81 to −2.77,p< 0.001;I2= 85%) in the arterial blood. Moreover, NPPV was also associated with early reduced respiratory rate (MD: −12.90, 95% CI: −22.21 to −3.60,p= 0.007;I2= 71%), improved symptom score (SMD: −1.85, 95% CI: −3.65 to −0.07,p= 0.04;I2= 92%), and shortened hospital stay (MD: −1.82 days, 95% CI: −2.32 to −1.31,p< 0.001;I2= 0%). No severe adverse events related to NPPV were reported.ConclusionsNPPV in children with acute asthma is associated with improved gas exchange, decreased respiratory rates, a lower symptom score, and a shorter hospital stay. These results suggest that NPPV may be as effective and safe as conventional treatment for pediatric patients with acute asthma.