Does Early Magnesium in Pediatric Asthma Reduce PICU Admission?

August 16, 2023

Written by Megan Hilbert

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Asthma is a common disease in childhood and results in many hospital admissions. This study was aimed at evaluating whether admission (specifically to the PICU) could be avoided by early magnesium sulfate administration for severe asthma exacerbation.

O[Mg], timing of IV magnesium doesn’t matter?!
In a hospital system rife with over-crowding, potentially avoiding admission or being able to predict what resources will be needed (ie: level of admission – floor vs ICU) can help with determination of disposition. The authors of this paper posited that early administration of magnesium sulfate for severe asthma exacerbation in pediatric patients could result in quicker symptomatic improvement and potential avoidance of ICU admission. The severity of the exacerbation was determined upon arrival to the ED via a respiratory clinical score (RCS); comprised of a combination of respiratory rate, presence or absence of retractions and wheeze, and degree of dyspnea (see local algorithm and RCS). A score > 9 was classified as a severe exacerbation. It was for those patients that IV magnesium was considered part of first line medications.

While there were factors independently associated with admission to the PICU (i.e.: diagnosis of status asthmaticus, arrival to the ED via ambulance, prior history of PICU admission for asthma exacerbation), timing of magnesium administration was not one of them.  Some limitations of this study include its retrospective nature, potential selection bias – given that sicker patients often receive magnesium earlier as standard of care, no way to control for how many treatments patient received prior to arrival to the ED, and the concurrent administration of multiple medications.

How will this change my practice?
Ultimately this was a well thought out study and an interesting premise, with promising clinical implications, but there are far too many confounders to truly formulate changes to standard of care at this time.

Source
Early Intravenous Magnesium Sulfate Administration in the Emergency Department for Severe Asthma Exacerbations. Pediatr Emerg Care. 2023 Jul 1;39(7):524-529. doi: 10.1097/PEC.0000000000002890. Epub 2023 Jan 8.