Management of severe acute asthma in childhood: Impact of intravenous magnesium therapy

Objective: The use of intravenous (IV) magnesium sulfate (SO 4 Mg) in the treatment of severe acute asthma (SAA) is more common in Paediatric Intensive Care Unit (PICU) since the publication of the Global Initiative for Asthma (GINA) recommendations in 2011. The objective of our study was to assess the impact of this therapeutical strategy on the outcomes of patients with SAA. Patients and methods: Patients referred to the University Hospital PICU for SAA between January 2009 and December 2012 were retrospectively included. We compared two groups of patients, based on the dates of their PICU admission and the introduction of the GINA recommendations in the clinical practice in 2011: group 1: patients admitted in 2009 and 2010; group 2: patients admitted in 2011 and 2012. Results: 63 patients were included: 32 in group 1 and 31 in group 2. The mean age was 4.8 years. All patients were treated by nebulized bronchodilators and systemic corticosteroids. No patients had been treated by SO 4 Mg in group 1, compared to 24 patients in group 2. The mean duration of hospitalization and ventilatory support were not different between the 2 groups. However, in group 2, when SO 4 Mg was used prior to the IV salbutamol administration, the mean oxygen therapy duration, mean hospitalization in the PICU and total duration of hospitalization were significantly shorter (respectively, 31 vs 194 hours; 2.7 vs 9 days; 5 vs 13 days; p<0.05). Conclusion: The efficacy of IV SO 4 Mg in SAA, when used within the first hour as recommended by the GINA, seems to be a major factor for optimal efficacy.