High-Dose Magnesium Sulfate Infusion for Severe Asthma in the Emergency Department: Efficacy Study.

Abstract

OBJECTIVE:

To assess the efficacy of a high-dose prolonged magnesium sulfate infusion in patients with severe, noninfectious-mediated asthma.

DESIGN:

Prospective, randomized, open-label study.

SETTING:

Twenty-nine-bed pediatric emergency department located in a children's hospital in Asuncion, Paraguay.

PATIENTS:

All patients of 6-16 years old who failed to improve after 2 hours of standard therapy for asthma.

INTERVENTIONS:

Subjects were randomized to receive magnesium sulfate, 50 mg/kg over 1 hour (bolus) or high-dose prolonged magnesium sulfate infusion of 50 mg/kg/hr for 4 hours (max, 8.000 mg/4 hr). Patients were monitored for cardiorespiratory complications.

MEASUREMENTS AND MAIN RESULTS:

Asthma severity was assessed via asthma scores and peak expiratory flow rates at 0-2-6 hours. The primary outcome was discharge to home at 24 hours. An analysis of the hospital length of stay and costs was a secondary outcome. Thirty-eight patients were enrolled, 19 in each group. The groups were of similar ages, past medical history of asthma, asthma score, and peak expiratory flow rate. There was a significant difference in the patients discharged at 24 hours: 47% in high-dose prolonged magnesium sulfate infusion (9/19) versus 10% (2/21) in the bolus group (p = 0.032) with an absolute risk reduction 37% (95% CI, 10-63) and a number needed to treat of 2.7 (95% CI, 1.6-9.5) to facilitate a discharge at or before 24 hours. The length of stay was shorter in the high-dose prolonged magnesium sulfate infusion group (mean ± SD in hr: high-dose prolonged magnesium sulfate infusion, 34.13 ± 19.54; bolus, 48.05 ± 18.72; p = 0.013; 95% CI, 1.3-26.5). The cost per patient in the high-dose prolonged magnesium sulfate infusion group was one third lower than the bolus group (mean ± SD: high-dose prolonged magnesium sulfate infusion, $603.16 ± 338.47; bolus, $834.37 ± 306.73; p < 0.016). There were no interventions or discontinuations of magnesium sulfate due to adverse events.

CONCLUSIONS:

The early utilization of high-dose prolonged magnesium sulfate infusion (50 mg/kg/hr/4 hr), for non-infectious mediated asthma, expedites discharges from the emergency department with significant reduction in healthcare cost.

• Authors: Jose E Irazuzta, Fatima Paredes, Viviana Pavlicich, Sara L Domínguez
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 17 Issue 2 Pg. e29-33 (Feb 2016) ISSN: 1529-7535 [Print] United States
• PMID: 26649938 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Bronchodilator Agents
• Magnesium Sulfate

Topics

• Adolescent
• Asthma (drug therapy)
• Bronchodilator Agents (administration & dosage, adverse effects)
• Child
• Emergency Service, Hospital
• Female
• Health Care Costs (statistics & numerical data)
• Humans
• Infusions, Intravenous
• Length of Stay (statistics & numerical data)
• Magnesium Sulfate (administration & dosage, adverse effects)
• Male
• Paraguay
• Peak Expiratory Flow Rate (drug effects)
• Prospective Studies
• Treatment Outcome