I had prepared this before the 3MG trial came out and hat tip to simon carley and his post for alerting me to it.
UPDATE: have since read the 3MG trial and here’s my thoughts on that
In my current dept, there’s a monthly joint ICU/ED meeting. I recently presented on some of the evidence base and strategies for managing life-threatening asthma. The 15 people there seemed to enjoy it so now i’m sharing it with the rest of the #FOAMed community.
I’ve included some references below from some of the papers cited in the talk.
Two talks in particular deserve mention.
Lim, Wei Jie, Redhuan Mohammed Akram, Kristin V Carson, Satya Mysore, Nadina A Labiszewski, Jadwiga A Wedzicha, Brian H Rowe, and Brian J Smith. “Non-Invasive Positive Pressure Ventilation for Treatment of Respiratory Failure Due to Severe Acute Exacerbations of Asthma..” Cochrane Database of Systematic Reviews (Online) 12 (2012): CD004360. doi:10.1002/14651858.CD004360.pub4.
Mohammed, S, and S Goodacre. “Intravenous and Nebulised Magnesium Sulphate for Acute Asthma: Systematic Review and Meta-Analysis..” Emergency Medicine Journal 24, no. 12 (December 2007): 823–830. doi:10.1136/emj.2007.052050.
Nair, Parameswaran, Stephen J Milan, and Brian H Rowe. “Addition of Intravenous Aminophylline to Inhaled Beta(2)-Agonists in Adults with Acute Asthma..” Cochrane Database of Systematic Reviews (Online) 12 (2012): CD002742. doi:10.1002/14651858.CD002742.pub2.
Rowe, B H, J A Bretzlaff, C Bourdon, G W Bota, and C A Camargo. “Magnesium Sulfate for Treating Exacerbations of Acute Asthma in the Emergency Department..” Cochrane Database of Systematic Reviews (Online) no. 2 (2000): CD001490. doi:10.1002/14651858.CD001490.
Tobin, A. “Intravenous Salbutamol: Too Much of a Good Thing?.” Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine 7, no. 2 (June 2005): 119–127.
“British Guideline on the Management of Asthma” (February 2, 2012): 1–151.
I had some correspondence from the author of this paper [free full text] regarding the ‘atrial calming’ effect of magnesium. I certainly gave lots of IV magnesium for patients in fast AF. Usually not for the ‘lone AF’ patients, but the sickies with pneumonias and deranged electrolytes. I’d never considered that the supposed rate control effect of magnesium might be useful in the asthmatic to help control the slightly ridiculous tachycardia you get if you’re doing it right.
As mentioned, the paper is free and well worth a read and a good reference.