Written by Kimiko Dunbar
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Patients with asthma who require magnesium, more oxygen, have atelectasis on CXR or higher social disparities are more likely to be admitted to the PICU.
Got mag?
This retrospective cohort study analyzed 252 pediatric intensive care unit (PICU) admissions for asthma in three Paris hospitals from 2019–2020. Children ages 6 months to 18 years were included. For those less than 3 years old, a diagnosis of asthma was retained if they had 3 or more prior episodes of wheeze. Respiratory support (i.e. high flow, non-invasive or invasive ventilation) was required in 17.5% of cases, with younger children at higher risk (2.37 vs. 4.18 years, p=0.002). Risk factors for respiratory support included having received magnesium sulfate (RR 4.48, p=0.001), high oxygen needs of ≥ 6 L/min (RR 2.86, p=0.03), and atelectasis on CXR (RR 3.38, p<0.01). Use of magnesium or higher levels of oxygen are likely reflective of a more severe asthma exacerbation, not a risk factor in and of itself. Social disparities correlated with multiple PICU admissions. Patients with poor long-term background treatment and/or viral coinfection were also more likely to require admission to the ICU. There were no specific criteria for ICU admission defined across the three different hospitals, which is a limitation of the study.
How will this change my practice?
It’s not entirely surprising that children who have a more severe exacerbation requiring mag or more oxygen support are more likely to require PICU admission. This study provides evidence for a higher index of suspicion for potential decompensation in this population. Further, the authors also support an obvious need to address social determinants of health in asthma management, which continues to be a serious risk factor for poorly controlled asthma. (See this JournalFeed post on peds asthma updates for more deets.)
Source
Features of children with critical asthma hospitalized in a pediatric intensive care unit: Results from the ICU-3A study. Pediatr Pulmonol. 2025 Jan;60(1):e27322. doi: 10.1002/ppul.27322. Epub 2024 Oct 14. PMID: 39400483
