Brooks Rebecca, Babushkin Vladislav, Rekhtman David, Cohen-Cymberknoh Malena, Shoseyov David, Shavit Itai
Department of Pediatrics, Pediatric Intensive Care Unit, Mount Scopus Hospital, Hadassah Medical Center, Jerusalem, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
J Paediatr Child Health. 2025 Apr;61(4):623-627. doi: 10.1111/jpc.16799. Epub 2025 Jan 28.
To assess the effectiveness of intravenous caffeine citrate in paediatric asthma exacerbation unresponsive to beta2-agonists and steroids.
A 10-year retrospective cohort study was conducted on asthmatic children unresponsive to beta2-agonists and steroids, who were treated with either intravenous caffeine citrate or magnesium sulphate. The study outcomes were changes in the Paediatric Respiratory Assessment Measure (PRAM) score, duration of oxygen therapy and paediatric intensive care unit (PICU) length-of-stay.
Overall, 296 children were treated in the PICU between January 1, 2011, and December 31, 2020. Fifteen and 26 children unresponsive to beta2-agonists and steroids (median ages 2.3 [0.7-11] and 3.0 [1.2-8.5] years), respectively, received caffeine citrate and magnesium sulphate. The two groups showed similar demographic characteristics and baseline parameters. At 24 and 48 h, the median (IQR) PRAM scores for the caffeine and magnesium groups were 4 (2-6) and 5 (4-6), respectively (p = 0.27), and 7 (6-8) and 8 (5-9), respectively (p = 0.57). The median (IQR) durations of PICU stay for the caffeine and magnesium groups were 36 (19-46) and 32 (23-45) h, respectively (p = 0.77). The median (IQR) durations of oxygen therapy for the caffeine and magnesium groups were 25 (10-30) and 20 (15-30) h, respectively (p = 0.29). No serious adverse events occurred in the caffeine group. One occurred in the magnesium group.
Caffeine citrate and magnesium sulphate demonstrated comparable effectiveness in treating steroid- and beta2-agonist-resistant asthma. A multicentre prospective study is needed to validate these results.
评估静脉注射枸橼酸咖啡因对β2受体激动剂和类固醇治疗无效的小儿哮喘急性发作的疗效。
对10年间对β2受体激动剂和类固醇治疗无效的哮喘患儿进行回顾性队列研究，这些患儿接受了静脉注射枸橼酸咖啡因或硫酸镁治疗。研究结局包括儿科呼吸评估量表（PRAM）评分的变化、氧疗持续时间和儿科重症监护病房（PICU）住院时间。
总体而言，2011年1月1日至2020年12月31日期间，PICU共治疗了296名儿童。分别有15名和26名对β2受体激动剂和类固醇治疗无效的儿童（中位年龄分别为2.3[0.7-11]岁和3.0[1.2-8.5]岁）接受了枸橼酸咖啡因和硫酸镁治疗。两组的人口统计学特征和基线参数相似。在24小时和48小时时，枸橼酸咖啡因组和硫酸镁组的PRAM评分中位数（IQR）分别为4（2-6）和5（4-6）（p=0.27），以及7（6-8）和8（5-9）（p=0.57）。枸橼酸咖啡因组和硫酸镁组的PICU住院时间中位数（IQR）分别为36（19-46）小时和32（23-45）小时（p=0.77）。枸橼酸咖啡因组和硫酸镁组的氧疗持续时间中位数（IQR）分别为25（10-30）小时和20（15-30）小时（p=0.29）。枸橼酸咖啡因组未发生严重不良事件。硫酸镁组发生了1例。
枸橼酸咖啡因和硫酸镁在治疗对类固醇和β2受体激动剂耐药的哮喘方面显示出相当的疗效。需要进行多中心前瞻性研究来验证这些结果。
