Escalation in Therapy Based on Intravenous Magnesium Sulfate Dosing in Pediatric Patients With Asthma Exacerbations
| Autor: | Sierra D. Stauber, Christine A. Kapuscinski, David J. Hutchinson |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Asthma exacerbations Exacerbation business.industry Magnesium Clinical Investigations chemistry.chemical_element 030208 emergency & critical care medicine Emergency department medicine.disease 03 medical and health sciences 0302 clinical medicine chemistry Internal medicine Pediatrics Perinatology and Child Health Medicine Pharmacology (medical) 030212 general & internal medicine Dosing business Intravenous magnesium Asthma |
| Zdroj: | J Pediatr Pharmacol Ther |
| ISSN: | 1551-6776 |
| Popis: | OBJECTIVE Our objective was to compare doses of intravenous magnesium sulfate and their association with escalations in therapy in children and adolescents presenting to the emergency department with an asthma exacerbation. METHODS This was a retrospective cohort study among children who received both magnesium sulfate and standard of care therapy for asthma exacerbations. A classification and regression tree (CART) analysis was performed to identify a breakpoint in dose in which a difference in the primary outcome was present. The primary endpoint was need for escalation in therapy within 24 hours of initial magnesium sulfate dose, defined as need for invasive or non-invasive mechanical ventilation or need for adjunctive therapy, that is, epinephrine, terbutaline, aminophylline, theophylline, ketamine, heliox, or additional doses of magnesium sulfate. RESULTS A total of 210 patients were included in the study. A CART analysis identified that a breakpoint of 27 mg/kg of magnesium was associated with a difference in the primary outcome of escalation in therapy in patients 27 mg/kg had a higher incidence of the primary outcome of escalation in therapy, 15 patients (18.3%) versus 3 patients (4.5%) in the ≤27-mg/kg/dose group (p = 0.011). CONCLUSIONS Our results demonstrate larger doses of magnesium sulfate are associated with an increased need for invasive or non-invasive mechanical ventilation or need for adjunctive therapy(ies). Our findings are limited by confounding factors that may have influenced this outcome in our population. |
| Databáze: | OpenAIRE |
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