硫酸镁长时间输注治疗儿童难治性哮喘持续状态的疗效与安全性
Efficacy and Safety of Prolonged Magnesium Sulfate Infusions in Children With Refractory Status Asthmaticus.
作者信息
Taher Khalid W, Johnson Peter N, Miller Jamie L, Neely Stephen B, Gupta Neha
机构信息
Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, United States.
Office of Instruction, Assessment, and Faculty/Staff Development, University of Oklahoma College of Pharmacy, Oklahoma City, OK, United States.
出版信息
Front Pediatr. 2022 Jun 9;10:860921. doi: 10.3389/fped.2022.860921. eCollection 2022.
OBJECTIVES
There is a paucity of data on the use of intravenous magnesium sulfate infusion in children with refractory status asthmaticus. The purpose of this study was to evaluate the efficacy and safety of prolonged magnesium sulfate infusion as an advanced therapy.
METHODS
This is a single center retrospective study of children admitted to our pediatric intensive care unit (PICU) with status asthmaticus requiring continuous albuterol. Treatment group included patients receiving magnesium for ≥4 h and control group included those on other therapies only. Patients were matched 1:4 based on age, sex, obesity, pediatric index of mortality III and pediatric risk of mortality III scores. Primary outcomes included PICU length of stay (LOS) and mechanical ventilation (MV) requirement. Secondary outcomes included mortality, extracorporeal membrane oxygenation (ECMO) requirement, analyses of factors associated with PICU LOS and MV requirement and safety of magnesium infusion. Logistic and linear regressions were employed to determine factors associated with MV requirement and PICU LOS, respectively.
RESULTS
Treatment and control groups included 27 and 108 patients, respectively. Median initial infusion rate was 15 mg/kg/hour, with median duration of 28 h. There was no difference in the MV requirement between the treatment and control groups [7 (25.9%) vs. 20 patients (18.5%), = 0.39]. Median PICU LOS and ECMO use were significantly higher in treatment vs. control group [(3.63 vs. 1.09 days, < 0.01) and (11.1 vs. 0%, < 0.01), respectively]. No mortality difference was noted. On regression analysis, patients receiving ketamine and higher prednisone equivalent dosing had higher odds of MV requirement [OR 19.29 (95% CI 5.40-68.88), < 0.01 and 1.099 (95% CI 1.03-1.17), < 0.01, respectively]. Each mg/kg increase in prednisone equivalent dosing corresponded to an increase in PICU LOS by 0.13 days (95% CI 0.096-0.160, < 0.01). Magnesium infusions were not associated with lower MV requirement or lower PICU LOS after controlling for covariates. Fourteen (51.9%) patients in the treatment group had an adverse event, hypotension being the most common.
CONCLUSION
Magnesium sulfate infusions were not associated with MV requirement, PICU LOS or mortality.
目的
关于静脉输注硫酸镁治疗难治性哮喘持续状态儿童的数据较少。本研究的目的是评估延长硫酸镁输注作为一种高级治疗方法的疗效和安全性。
方法
这是一项单中心回顾性研究，纳入了入住我们儿科重症监护病房（PICU）且患有哮喘持续状态需要持续使用沙丁胺醇的儿童。治疗组包括接受硫酸镁治疗≥4小时的患者，对照组仅包括接受其他治疗的患者。根据年龄、性别、肥胖、儿科死亡率指数III和儿科死亡风险III评分，患者按1:4进行匹配。主要结局包括PICU住院时间（LOS）和机械通气（MV）需求。次要结局包括死亡率、体外膜肺氧合（ECMO）需求、与PICU LOS和MV需求相关的因素分析以及硫酸镁输注的安全性。采用逻辑回归和线性回归分别确定与MV需求和PICU LOS相关的因素。
结果
治疗组和对照组分别包括27例和108例患者。初始输注速率中位数为15mg/kg/小时，持续时间中位数为28小时。治疗组和对照组在MV需求方面无差异[7例（25.9%）对20例患者（18.5%），P = 0.39]。治疗组的PICU LOS中位数和ECMO使用率显著高于对照组[分别为（3.63天对1.09天，P < 0.01）和（11.1%对0%，P < 0.01）]。未观察到死亡率差异。回归分析显示，接受氯胺酮治疗且泼尼松等效剂量较高的患者MV需求的几率更高[OR分别为19.29（95%CI 5.4～68.88），P < 0.01和1.099（95%CI 1.03～1.17），P < 0.01]。泼尼松等效剂量每增加1mg/kg，PICU LOS增加0.13天（95%CI 0.096～0.160，P < 0.01）。在控制协变量后，硫酸镁输注与较低的MV需求或较短的PICU LOS无关。治疗组中有14例（51.9%）患者发生不良事件，最常见的是低血压。
结论
硫酸镁输注与MV需求、PICU LOS或死亡率无关。
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