Clinical outcomes of children with acute asthma managed with intravenous magnesium sulfate outside intensive care setting

Asthma in children constitutes a well-known respiratory condition with significant mortality. In poorly controlled asthma, multiple adjunct therapies, including magnesium sulfate (MS), are recommended to decrease the likelihood of intubation; however, limited evidence exists to support their routine usage in day-to-day situations. The aim of this study is to determine the outcomes of pediatric patients treated with MS during exacerbations of asthma admitted at a tertiary care unit. A retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan, from January 2019 to December 2021. Patients aged 6 years to 15 years who presented with acute asthma through the emergency room, having a clinical respiratory score of more than 5, and were admitted to the high-dependency unit (HDU) were included in the study. Patients who were started on MS within 24 hours of admission were categorized in the MS group. Patients receiving all standard acute asthma treatment but were not started on magnesium therapy within 24 hours of admission were categorized in the non-MS group. Different outcome variables were compared between the groups. A total of 110 patients with asthma were enrolled. A total of 54 patients were categorized into the MS group, while 56 were included in the non-MS group. Fewer patients were transferred from HDU to the pediatric intensive care unit (PICU) (24.07%) in the MS group compared to the non-MS group (42.85%), (p=0.02). In the MS group, the mean number of days spent on oxygen in HDU was 2.38±0.81, while the non-MS group spent more days (3.10±0.84) (p<0.01). This study demonstrates that for pediatric patients with severe asthma exacerbations, administration of intravenous MS (within 24 hours) is beneficial, results in fewer admissions to PICU, and reduces the mean number of days spent on oxygen therapy.