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Early Intravenous Magnesium Sulfate Administration in the Emergency Department for Severe Asthma Exacerbations
Brian L Forster1, Fridtjof Thomas2, Sandra R Arnold3
1From the Division of Emergency Services, Department of Pediatrics, The University of Tennessee Health Science Center and Le Bonheur Children's Hospital.
Insights
Early intravenous magnesium sulfate (IVMg) did not reduce pediatric intensive care unit (PICU) admissions for severe asthma exacerbations. This study found no significant benefit in using IVMg within 60 minutes for these critically ill children.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Severe asthma exacerbations are common in children and frequently lead to pediatric intensive care unit (PICU) admissions.
- Intravenous magnesium sulfate (IVMg) is a potential treatment for severe asthma, but its efficacy in reducing PICU admissions requires further investigation.
Purpose of the Study:
- To evaluate whether early IVMg administration (within 60 minutes) in pediatric patients with severe asthma exacerbations (Respiratory Clinical Score [RCS] 9-12) decreases PICU admission rates.
- To identify factors associated with PICU admission in this patient cohort.
Main Methods:
- Retrospective chart review of 1911 pediatric patients (2-17 years) with severe asthma exacerbations.
- Univariable and multivariable logistic regression analyses were employed to assess the association between early IVMg treatment and PICU admission.
- Analysis included controlling for covariates such as mode of arrival, asthma history, and diagnosis.
Main Results:
- Of 1911 patients, 13% were admitted to the PICU. Early IVMg administration (within 60 minutes) was associated with an increased odds ratio (OR) for PICU admission (OR, 1.63).
- Other factors linked to higher PICU admission odds included ambulance arrival (OR, 2.23), prior PICU admission for asthma (OR, 1.73), and status asthmaticus diagnosis (OR, 8.88).
- For patients receiving early IVMg, increasing RCS scores (10-12) showed a dose-dependent increase in the OR for PICU admission compared to RCS 9.
Conclusions:
- Early administration of IVMg in pediatric patients with severe asthma exacerbations, as defined by RCS 9-12, did not lead to a reduction in PICU admissions.
- The findings suggest that early IVMg may not be an effective strategy for preventing PICU admission in this population and might even be associated with increased PICU utilization.
Background:
Severe asthma exacerbations in pediatric patients occur frequently and can require pediatric intensive care unit (PICU) admission.
Objective:
To determine if early administration of intravenous magnesium sulfate (IVMg) to pediatric patients experiencing severe asthma exacerbations, defined as a respiratory clinical score (RCS) of 9 to 12, resulted in fewer PICU admissions.
Methods:
Retrospective chart review of pediatric patients aged from 2 to 17 years presenting with a severe asthma exacerbation to a single tertiary care pediatric emergency department. Univariable and multivariable logistic regression analyses were used to determine if admission to the PICU was associated with early IVMg treatment, within 60 minutes of registration.
Results:
A total of 1911 patients were included in the study, of which 1541 received IVMg. The average time to IVMg was 79 minutes, with 35% of the patients receiving it within 60 minutes of arrival. Two hundred forty-eight (13%) were admitted to the PICU, 641 (34%) were admitted to the general inpatient floor, and 1022 (53%) were discharged home. Factors associated with increased odds ratio (OR) of PICU admission were: early IVMg (OR, 1.63; 95% CI: 1.16-2.28), arrival mode to the emergency department via ambulance (OR, 2.23; 95% CI: 1.45-3.43), history of PICU admission for asthma (OR, 1.73; 95% CI: 1.22-2.44), and diagnosis of status asthmaticus (OR, 8.88; 95% CI: 3.49-30.07). Calculated OR of PICU admission subcategorized by RCS for early IVMg patients, after controlling for PICU risk factors, are as follows: RCS 9 (reference), RCS 10 (OR, 2.52; 95% CI: 0.89-2.23), RCS 11 (OR, 2.19; 95% CI: 1.3-3.70), and RCS 12 (OR, 4.12; 95% CI: 2.13-7.95).
Conclusions:
Early administration of IVMg to pediatric patients experiencing severe asthma exacerbations does not result in fewer PICU admissions.
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