Trends in Intravenous Magnesium Use and Outcomes for Status Asthmaticus in Children's Hospitals from 2010 to 2017

Abstract

<jats:p>Intravenous (IV) magnesium is used as an adjunct therapy in management of status asthmaticus with a goal of reducing intubation rate. A recent review suggests that IV magnesium use in status asthmaticus reduces admission rates. This is contrary to the observation of practicing emergency room physicians. The goal of this study was to assess trends in IV magnesium use for status asthmaticus in US children’s hospitals over 8 years through a retrospective analysis of children younger than 18 years using the Pediatric Health Information System database. Outcomes were IV magnesium use, inpatient and intensive care unit admission rate, geometric mean length of stay, and 7-day all-cause readmission rate. IV magnesium use for asthma hospitalization more than doubled over 8 years (17% vs. 36%; P &lt; .001). Yearly trends were not significantly associated with hospital or intensive care unit admission rate or 7-day all-cause readmissions, although length of stay was reduced (P &lt; .001).</jats:p>

A Novel U-Shaped Association Between Serum Magnesium on Admission and 28-Day In-hospital All-Cause Mortality in the Pediatric Intensive Care Unit

“…Across the United States, there has been a significant increase in the use of intravenous magnesium for the treatment of children with worsening asthma. However, magnesium replacement therapy has not been associated with changes in hospitalization rates, ICU admissions, or 7-day all-cause readmission rates ( 33 ).…”

Is intravenous magnesium sulphate safe to be administered outside the critical care setting?

“…13 Between 2010 and 2017, intravenous MgSO 4 prescribing in an American cohort of 878 188 hospitalised children increased from 17% to 36%. 14 Despite increasing clinical use, concerns regarding side effects of intravenous MgSO 4 persist, namely hypotension, vasodilation and respiratory depression. 3,6,12,15,16 As such, intravenous MgSO 4 is generally administered in the critical care setting.…”

Stating the obvious: intravenous magnesium sulphate should be the first parenteral bronchodilator in paediatric asthma exacerbations unresponsive to first-line therapy

“…The acceptance of intravenous MgSO 4 is again reflected in a nationwide survey from the Netherlands, where 96% of the respondents reported its use in children who failed to respond to first-line asthma therapy [ 37 ]. Perhaps the most telling evidence of the increasing recognition of intravenous MgSO 4 in status asthmaticus is that its use has almost doubled across children's units across the USA over the past decade [ 38 ]. A concurrent reduction in the length of hospital stay, from 1.6 days in 2010 to 1.4 days in 2017, was also noted in this review.…”