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Efficacy and Safety of Prolonged Magnesium Sulfate Infusions in Children With Refractory Status Asthmaticus
Khalid W Taher1, Peter N Johnson1, Jamie L Miller1
1Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, United States.
Insights
Prolonged magnesium sulfate infusions in children with refractory status asthmaticus did not reduce mechanical ventilation needs or intensive care unit length of stay. This advanced therapy was associated with increased length of stay and adverse events like hypotension.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Refractory status asthmaticus in children poses significant treatment challenges.
- Intravenous magnesium sulfate is an advanced therapy option with limited data on its efficacy and safety in this pediatric population.
Purpose of the Study:
- To evaluate the efficacy and safety of prolonged intravenous magnesium sulfate infusion in children with refractory status asthmaticus.
- To assess the impact of magnesium sulfate on pediatric intensive care unit (PICU) length of stay (LOS) and mechanical ventilation (MV) requirements.
Main Methods:
- A single-center retrospective study compared children with status asthmaticus receiving magnesium sulfate infusion (≥4 hours) versus those on other therapies.
- Patients were matched 1:4 based on demographic and severity scores.
- Primary outcomes included PICU LOS and MV requirement; secondary outcomes included mortality, ECMO, and safety.
Main Results:
- No significant difference in MV requirement between magnesium sulfate and control groups (25.9% vs. 18.5%).
- Significantly higher PICU LOS (3.63 vs. 1.09 days) and extracorporeal membrane oxygenation (ECMO) use (11.1% vs. 0%) in the magnesium group.
- Adverse events, primarily hypotension, occurred in 51.9% of the magnesium treatment group.
Conclusions:
- Prolonged magnesium sulfate infusions were not associated with reduced MV requirement or PICU LOS in pediatric refractory status asthmaticus.
- The therapy did not impact mortality but was linked to increased LOS and adverse events.
Objectives:
There is a paucity of data on the use of intravenous magnesium sulfate infusion in children with refractory status asthmaticus. The purpose of this study was to evaluate the efficacy and safety of prolonged magnesium sulfate infusion as an advanced therapy.
Methods:
This is a single center retrospective study of children admitted to our pediatric intensive care unit (PICU) with status asthmaticus requiring continuous albuterol. Treatment group included patients receiving magnesium for ≥4 h and control group included those on other therapies only. Patients were matched 1:4 based on age, sex, obesity, pediatric index of mortality III and pediatric risk of mortality III scores. Primary outcomes included PICU length of stay (LOS) and mechanical ventilation (MV) requirement. Secondary outcomes included mortality, extracorporeal membrane oxygenation (ECMO) requirement, analyses of factors associated with PICU LOS and MV requirement and safety of magnesium infusion. Logistic and linear regressions were employed to determine factors associated with MV requirement and PICU LOS, respectively.
Results:
Treatment and control groups included 27 and 108 patients, respectively. Median initial infusion rate was 15 mg/kg/hour, with median duration of 28 h. There was no difference in the MV requirement between the treatment and control groups [7 (25.9%) vs. 20 patients (18.5%), p = 0.39]. Median PICU LOS and ECMO use were significantly higher in treatment vs. control group [(3.63 vs. 1.09 days, p < 0.01) and (11.1 vs. 0%, p < 0.01), respectively]. No mortality difference was noted. On regression analysis, patients receiving ketamine and higher prednisone equivalent dosing had higher odds of MV requirement [OR 19.29 (95% CI 5.40-68.88), p < 0.01 and 1.099 (95% CI 1.03-1.17), p < 0.01, respectively]. Each mg/kg increase in prednisone equivalent dosing corresponded to an increase in PICU LOS by 0.13 days (95% CI 0.096-0.160, p < 0.01). Magnesium infusions were not associated with lower MV requirement or lower PICU LOS after controlling for covariates. Fourteen (51.9%) patients in the treatment group had an adverse event, hypotension being the most common.
Conclusion:
Magnesium sulfate infusions were not associated with MV requirement, PICU LOS or mortality.
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