Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Susannah Vanderpool, PharmD, MPH, BCPPS Co-Author: Jurido Olukunle, MD, FAAP, MPH – Pediatrician, Mimbres Memorial Medical Center Co-Author: Basant Hamed, MD, MPH – Pediatric Nephrology Fellow, State University of New York Downstate Medical Center Co-Author: Jeremy Weedon, Ph.D. – Biostatistician, State University of New York Downstate Health Sciences University Co-Author: Sule Doymaz, MD, FAAP – Assistant Professor of Pediatrics, Pediatric Intensivist, State University of New York Downstate Medical Cent
Introduction: Intravenous magnesium sulfate is commonly used in emergency departments to manage acute severe asthma in children; however, its effectiveness in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) for asthma remains less well-defined. This study examined clinical outcomes associated with intravenous magnesium sulfate use in children admitted to the PICU with acute severe asthma.
Methods: We conducted a retrospective cohort study of pediatric patients aged 1 to 18 years with acute severe asthma admitted to the PICU between 2016 and 2022. Patients were grouped based on whether they received IV magnesium sulfate following admission. The primary outcome was the duration of continuous albuterol therapy. Secondary outcomes included hospital length of stay (LOS), PICU LOS, and duration of non-invasive mechanical ventilation (NIMV). Mixed linear models were used to assess outcomes, adjusting for BMI at or above the 85th percentile, prior PICU admission, corticosteroid treatment duration of 5 days or more, and the use of mechanical ventilation.
Results: Of 85 patients, 37 (43.5%) received inpatient intravenous magnesium sulfate. Baseline characteristics were similar between groups. Intravenous magnesium sulfate use was associated with longer albuterol duration (30.7 vs. 21.6 hours; p = 0.021), PICU LOS (70.6 vs. 34.4 hours; p < 0.001), and hospital LOS (104.0 vs. 68.2 hours; p = 0.001). Among patients receiving ≥ 5 days of corticosteroids, hospital LOS remained significantly longer in the magnesium group (132.8 vs. 70.5 hours; p < 0.001). NIMV duration was also greater (31.5 vs. 16.3 hours; p = 0.021), although rates of NIMV use did not differ.
Conclusions: In critically ill children with acute severe asthma, intravenous magnesium sulfate use was associated with longer durations of bronchodilator therapy, respiratory support, and hospitalization, which may reflect greater baseline severity among treated patients rather than a lack of efficacy.
