Related Experiment Videos
Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled
L Ciarallo1, A H Sauer, M W Shannon
1Division of Emergency Medicine, Children's Hospital Boston, USA.
Insights
Intravenous magnesium (IVMg) therapy significantly improved short-term pulmonary function in pediatric patients with moderate to severe asthma exacerbations. This asthma treatment showed a higher likelihood of emergency department discharge without adverse blood pressure effects.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Pharmacology
Background:
- Asthma exacerbations in children can be severe and life-threatening.
- Standard treatments may not be sufficient for all patients.
- Intravenous magnesium sulfate is a potential adjunctive therapy.
Purpose of the Study:
- To evaluate the efficacy of intravenous magnesium (IVMg) therapy for moderate to severe asthma exacerbations in pediatric patients.
- To assess the impact of IVMg on pulmonary function and clinical outcomes.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted in an urban pediatric emergency department.
- Thirty-one pediatric patients (6-18 years) with severe asthma exacerbations received either magnesium sulfate infusion or a saline placebo.
- Pulmonary function tests, vital signs, and oxygen saturation were monitored over 110 minutes.
Main Results:
- The magnesium group showed significantly greater improvement in forced expiratory volume at 1 second and peak expiratory flow rate compared to placebo.
- Pulmonary function improvements in the magnesium group were sustained throughout the observation period.
- Patients receiving IVMg had a higher likelihood of discharge from the emergency department (p=0.03).
Conclusions:
- Intravenous magnesium sulfate is an effective adjunct therapy for moderate to severe pediatric asthma exacerbations.
- IVMg significantly improves short-term pulmonary function without altering blood pressure.
- This suggests a valuable role for IVMg in managing severe asthma attacks in children.
Objective:
To evaluate the efficacy of intravenous magnesium (IVMg) therapy for moderate to severe asthma exacerbations in pediatric patients.
Design:
Randomized, double-blind, placebo-controlled, clinical trial.
Setting:
Urban pediatric emergency department.
Participants:
Thirty-one patients aged 6 to 18 years who were being treated for an acute asthma exacerbation with peak expiratory flow rate (PEFR) less than 60% of the predicted value after receiving three beta 2-adrenergic nebulizer treatments.
Interventions:
Magnesium sulfate infusion, 25 mg/kg (maximum, 2 gm), or equivolume saline solution for 20 minutes.
Measurements And Results:
Vital signs, O2 saturation by pulse oximetry, PEFR, forced vital capacity, forced expiratory volume at 1 second, and physical examination were serially recorded for 110 minutes, with serum magnesium concentrations measured before and after the 20-minute infusion. At 50 minutes the magnesium group had a significantly greater percentage of improvement from baseline in forced expiratory volume at 1 second (34% vs -1%; p = 0.05); this improvement was sustained and even greater at 110 minutes (75% vs 5%; p = 0.01). Results were similar for PEFR at 80 through 110 minutes (59% vs 20% at 110 minutes; p = 0.05) and for forced vital capacity (55% vs 8% at 80 minutes; p = 0.05). There were no significant intergroup differences in blood pressure at any point. Patients who received intravenous magnesium infusions were more likely to be discharged home from the emergency department than those who received placebo (4/15 vs 0/16; p = 0.03).
Conclusions:
Children treated with intravenous magnesium infusions for moderate to severe asthma had significantly greater improvement in short-term pulmonary function without any significant alteration in blood pressure, suggesting a role for this agent as an adjunct in the treatment of such patients.