.jpg "Khalid Taher, BCPS, PharmD photo")
Khalid Taher, BCPS, PharmD
Pediatric Clinical Pharmacist, Adjunct Assistant Professor
King Faisal Specialist Hospital & Research Center-Riyadh-Saudi Arabia
Oklahoma City, Oklahoma
Disclosure information not submitted.
Peter Johnson, PharmD, BCPPS, FPPA
Professor of Pharmacy and Pediatric Critical Care Pharmacist
University of Oklahoma Health Sciences Center College of Pharmacy
Oklahoma City, Oklahoma
Disclosure information not submitted.
Jamie Miller, Pharm.D., BCPS, BCPPS, FPPA
Professor and Clinical Pharmacy Specialist--NICU
University of Oklahoma College of Pharmacy, United States
Disclosure information not submitted.
Stephen Neely, MPH
Research biostatistician
University of Oklahoma College of Pharmacy, United States
Disclosure information not submitted.
Neha Gupta, MD, FAAP
Assistant Professor
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma
Disclosure information not submitted.
Title: Magnesium sulfate continuous infusion in children with status asthmaticus
Introduction: There is a paucity of data on magnesium sulfate continuous infusions (MS-CIN) for children with refractory status asthmaticus. The purpose of this study was to evaluate the efficacy and safety of MS-CINs versus other therapies (terbutaline, aminophylline, or ketamine).
Methods: This was a retrospective study of children < 18 years of age with status asthmaticus requiring continuous albuterol from 01/01/2013-08/31/2020. The MS-CIN group included patients receiving magnesium for >4 hours and controls included those on other therapies only. Patients were matched 1:4 based on age, Pediatric Risk of Mortality III and Pediatric Index of Mortality III scores, obesity, and sex. The primary objectives included a comparison of pediatric intensive care unit (PICU) length of stay (LOS) and mechanical ventilation (MV) requirement. Secondary objectives included comparison of mortality and use of extracorporeal membrane oxygenation (ECMO) between groups and analyses of factors associated with PICU LOS and MV requirement. Logistic and linear regressions were employed to determine the associations for MV requirement and PICU LOS respectively while controlling for independent variables [continuous albuterol duration, cumulative prednisone equivalent dosing (mg/kg), ketamine exposure, and MS-CIN exposure].
Results: MS-CIN and control groups included 27 and 108 patients, respectively. There was no difference in the adjusted mean PICU LOS between the MS-CIN and control groups (2.9 days vs 2.8 days, p >0.05). There was no significant difference in the MV requirement between the MS-CIN and control groups [7 patients (25.9%) vs 20 patients (18.5%), p=0.389]. No differences in mortality and ECMO were noted. Patients receiving higher prednisone equivalent dosing and no MS-CINs had higher odds of MV requirement [OR 1.1 (95% CI 1.05-1.18) and OR 0.52 (95% CI 0.003-0.923), respectively]. Each mg/kg increase in prednisone equivalent dosing corresponded to an increase in PICU LOS by 0.13 days (95% CI 0.096-0.16).
Conclusions: There was no difference in mortality, PICU LOS, ECMO, and MV requirement between the two groups. Higher cumulative prednisone equivalent dosing was associated with a higher PICU LOS and MV requirement. MS-CINs were associated with lower odds of MV requirement. Further studies are needed to confirm these results.