Date of Award

Spring 2020

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Michael Huber

Abstract

Abstract

Introduction: Asthma is an extremely prevalent lung condition that comes with life-threatening exacerbations that are sometimes refractory to standard therapy regiments. Standard therapy regiments include short acting beta agonists, short acting muscarinic agonists, and inhaled corticosteroids. After initial therapy has failed there is a wide range of adjunctive medication that can be used. One medication that has demonstrated efficacy in these circumstances is intravenous magnesium sulfate. Magnesium sulfate toxicity may result in severe neurologic and cardiac conditions. Magnesium sulfate can be administered through a nebulizer machine; this route of administration would decrease the incidence of the adverse effects of magnesium sulfate toxicity and would negate the use of the intravenous catheter for administration of this medication. This review compares the efficacy of intravenous versus nebulized magnesium sulfate in the setting of severe acute asthma in a pediatric patient.

Methods: A literature search was conducted using PubMed and Google Scholar. Selected articles include six randomized controlled trials and one cohort study. Only studies that are recent and pertinent to the research were included.

Results: In four studies intravenous magnesium sulfate significantly improved outcomes of pediatric patients with acute asthma. In four studies nebulized magnesium sulfate significantly improved outcomes and in one study it did not significantly improve outcomes of pediatric patients with acute asthma. Lastly, in the two studies that directly compared the intravenous to the nebulized route of administration there was no significant difference in outcomes of the two samples.

Discussion: Results in this review are consistent with previously obtained results where there is acknowledged efficacy of an intravenous route of administration and mixed results surrounding nebulized route of administration. These inconsistent results for nebulized route of administration have led to a dismissal of the use of nebulized magnesium sulfate in clinical practice. A practitioner should not utilize a medication that is not supported by evidence, especially in a life-threatening situation. However, an important trend to note is that studies that found nebulized magnesium sulfate to be effective only included patients with severe asthma and the study that did not find it to improve outcomes included mild, moderate, and severe asthma.

Conclusion: These results actually demonstrate promise for the role of nebulized magnesium sulfate in severe acute refractory asthma, something that has previously lost favor. However, further randomized controlled trials are required to investigate the outcomes of pediatric patients with severe acute refractory asthma, as opposed to mild or moderate asthma, who receive nebulized magnesium sulfate in order to support this possibility. If further trials are performed it can have a great future impact on outcomes in this population by improving the patient’s asthma, reducing magnesium toxicity occurrence, and reducing intravenous catheter utilization or complications.

Additional Files

PICO Presentation Wilkinson.mp4 (6474 kB)
Video

PICO Poster Wilkinson.pptx (1286 kB)
Poster

PICO Poster References.pdf (39 kB)
Poster References

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Inhaled Vs. Nebulized Magnesium Sulfate in Severe Acute Refractory Asthma in Children

Abstract

Introduction: Asthma is an extremely prevalent lung condition that comes with life-threatening exacerbations that are sometimes refractory to standard therapy regiments. Standard therapy regiments include short acting beta agonists, short acting muscarinic agonists, and inhaled corticosteroids. After initial therapy has failed there is a wide range of adjunctive medication that can be used. One medication that has demonstrated efficacy in these circumstances is intravenous magnesium sulfate. Magnesium sulfate toxicity may result in severe neurologic and cardiac conditions. Magnesium sulfate can be administered through a nebulizer machine; this route of administration would decrease the incidence of the adverse effects of magnesium sulfate toxicity and would negate the use of the intravenous catheter for administration of this medication. This review compares the efficacy of intravenous versus nebulized magnesium sulfate in the setting of severe acute asthma in a pediatric patient.

Methods: A literature search was conducted using PubMed and Google Scholar. Selected articles include six randomized controlled trials and one cohort study. Only studies that are recent and pertinent to the research were included.

Results: In four studies intravenous magnesium sulfate significantly improved outcomes of pediatric patients with acute asthma. In four studies nebulized magnesium sulfate significantly improved outcomes and in one study it did not significantly improve outcomes of pediatric patients with acute asthma. Lastly, in the two studies that directly compared the intravenous to the nebulized route of administration there was no significant difference in outcomes of the two samples.

Discussion: Results in this review are consistent with previously obtained results where there is acknowledged efficacy of an intravenous route of administration and mixed results surrounding nebulized route of administration. These inconsistent results for nebulized route of administration have led to a dismissal of the use of nebulized magnesium sulfate in clinical practice. A practitioner should not utilize a medication that is not supported by evidence, especially in a life-threatening situation. However, an important trend to note is that studies that found nebulized magnesium sulfate to be effective only included patients with severe asthma and the study that did not find it to improve outcomes included mild, moderate, and severe asthma.

Conclusion: These results actually demonstrate promise for the role of nebulized magnesium sulfate in severe acute refractory asthma, something that has previously lost favor. However, further randomized controlled trials are required to investigate the outcomes of pediatric patients with severe acute refractory asthma, as opposed to mild or moderate asthma, who receive nebulized magnesium sulfate in order to support this possibility. If further trials are performed it can have a great future impact on outcomes in this population by improving the patient’s asthma, reducing magnesium toxicity occurrence, and reducing intravenous catheter utilization or complications.

 
 

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