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Intensive Asthma Therapy and Intravenous Magnesium Sulfate in the Emergency Department Management of Pediatric Asthma
Melissa Chiappetta1, David M Merolla2, Priya Spencer1
1Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan.
Insights
Intravenous magnesium sulfate (IVMg) given with intensive asthma therapy (IAT) in the emergency department did not improve albuterol timing but increased hospitalization odds in children. Further randomized trials are needed to confirm IVMg efficacy for pediatric asthma exacerbations.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Acute asthma exacerbations are a common reason for pediatric emergency department visits.
- Intensive asthma therapy (IAT) involving bronchodilators and corticosteroids is a standard treatment.
- Intravenous magnesium sulfate (IVMg) is sometimes used as an adjunctive therapy for severe asthma, but its efficacy in children receiving IAT is not well-established.
Purpose of the Study:
- To determine if IVMg administration alongside IAT in the emergency department is associated with hospitalization rates.
- To assess the impact of IVMg on the time to receiving albuterol every 4 hours among hospitalized children.
- To evaluate other outcomes such as the use of adjuvant medications and respiratory support.
Main Methods:
- Retrospective cohort study of children aged 2-18 years treated with IAT between 2019 and 2021.
- IAT defined as 3 bronchodilators and corticosteroids within 60 minutes of ED triage.
- Comparison between patients who received IAT with or without IVMg in the ED.
Main Results:
- Of 851 patient encounters, 61% received IAT with IVMg.
- Patients receiving IVMg had significantly increased odds of hospitalization (aOR 25.3, P < 0.001).
- IVMg was associated with longer time to albuterol every 4 hours (aOR 13.8, P < 0.001) and increased need for adjuvant medications and respiratory support.
Conclusions:
- In this observational study, IVMg use with IAT in the ED was linked to higher hospitalization rates without improving time to albuterol.
- The findings suggest that IVMg may not be beneficial and could potentially be detrimental for pediatric asthma exacerbations treated with IAT.
- Randomized controlled trials are necessary to definitively establish the efficacy and safety of IVMg in this patient population.
Objective:
The aim of the stud is to determine whether intravenous magnesium sulfate (IVMg) is associated with hospitalization and time to albuterol every 4 hours in a cohort of children who received intensive asthma therapy (IAT) in the emergency department (ED).
Methods:
This retrospective cohort study included children 2-18 years who received IAT, defined as 3 bronchodilators and corticosteroids within 60 minutes of ED triage, with or without IVMg in the ED between 2019 and 2021. Primary outcome was hospitalization and among hospitalized children, secondary outcome was time to albuterol every 4 hours. Additional secondary outcomes included adjuvant medications, respiratory support, and length of stay.
Results:
Among 851 patient encounters, 61% (n = 516) received IAT with IVMg in the ED and most patients were hospitalized (n = 565, 66%). Patients who received IVMg had increased odds of hospitalization (adjusted odds ratio [aOR] 25.3, 95% confidence interval [CI] 14.49-42.52, P < 0.001) and a longer time to albuterol every 4 hours (aOR 13.8, 95% CI 9.61-17.75, P < 0.001), even when controlling for demographic and clinical markers of severe asthma. In the adjusted analysis, patients who received IAT with IVMg had increased odds of adjuvant medications in the ED (aOR 7.3, 95% CI 2.97-17.95, P < 0.001) and respiratory support in the ED (aOR 3.6, 95% CI 2.22-5.85, P < 0.001) and the inpatient setting (aOR 3.9, 95% CI 1.87-7.97, P < 0.001).
Conclusions:
Children who received IAT and IVMg in the ED for management of an acute asthma exacerbation had significantly higher odds of hospitalization without any improvement in the time to albuterol every 4 hours for admitted patients. The results of this observational study underscore the need for randomized controlled trials to determine the efficacy of IVMg for acute pediatric asthma.
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