title: 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.
  
  
  METHODS
  Prospective, randomized, open-label study.
  
  
  METHODS
  Twenty-nine-bed pediatric emergency department located in a children's hospital in Asuncion, Paraguay.
  
  
  METHODS
  All patients of 6-16 years old who failed to improve after 2 hours of standard therapy for asthma.
  
  
  METHODS
  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.
  
  
  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.affiliation: 1Wolfson Children's Hospital, Jacksonville, FL. 2Hospital General Pediátrico Niños de Acosta Ñu, Asunción, Paraguay.
authors.forename: Jose E
authors.initials: JE
authors.lastname: Irazuzta
authors.forename: Fatima
authors.initials: F
authors.lastname: Paredes
authors.forename: Viviana
authors.initials: V
authors.lastname: Pavlicich
authors.forename: Sara L
authors.initials: SL
authors.lastname: Domínguez
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008278:Magnesium Sulfate / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D010239:Paraguay; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D008278:Magnesium Sulfate