Systematic Literature Review: IV Therapy for Pediatric Asthma Symptoms

This report presents a systematic literature review investigating the effectiveness of intravenous (IV) therapy in alleviating acute asthma symptoms in children presenting to the emergency department (ED). The study outlines a detailed search strategy across medical databases (BioMed Central, PubMed Central, and CINAHL) using relevant keywords and Boolean operators to identify pertinent articles. Inclusion and exclusion criteria, including publication years (2010-2019), language (English), and peer-review status, were applied to refine the search results. The review includes a PRISMA flow chart and a quality appraisal table evaluating the included studies. The report summarizes the findings of selected articles, including Griffiths & Kew (2016), Ibrahim & Elkolaly (2017), Albuali (2014), Bittar & Guerra (2012), and Sellers (2013), highlighting the methodologies, key findings, and relevance of each study. The review concludes that intravenous therapy, particularly with magnesium sulfate, demonstrates effectiveness in improving clinical outcomes for children with acute asthma in the ED. The report suggests further research and identifies the most appropriate journals for submitting the review, providing a justification for the selection based on the evidence.

1
Effectiveness of an Intravenous Therapy in the Relief of Acute Asthma Symptoms for
Children Presenting in Ed
Name of the Student
Name of the University
Author Note

Effectiveness of an Intravenous Therapy in the Relief of Acute Asthma Symptoms for
Children Presenting in Ed
Asthma is a respiratory disorder that is characterised by the airflow limitation in the lungs
caused by narrowing of airways. Severe episodes of acute asthma in children pose a potentially life-
threatening situation and are required to be presented to the emergency department (ED). These
children with acute asthma exacerbations are required immediate interventions to reduce the signs of
respiratory distress and help them get relief from the symptoms of acute asthma. The management of
such patients requires a comprehensive situation assessment by the paediatric healthcare
professionals and treatment considerations, to decrease chronic morbidity and prevent further
exacerbation. The paper aims to develop a search strategy to conduct a literature review on the
effectiveness of intravenous therapy in the relief of acute asthma symptoms for children presenting to
the ED.
Background
Even though acute exacerbations in asthma is standard, preventive measures are required to
limit and reduce the symptoms present, especially for the children admitted in the emergency
department. The current treatment approach recommended and undertaken by paediatricians are the
administration of a Short-Acting Beta Agonists via inhaling. Even though such administration
procedure is rapidly effective, it may not provide adequate bronchodilation required for the
restoration of appropriate lung function. Magnesium is an effective bronchodilator and common in
emergency department hospitalisations. However, the method of administration of magnesium can
be either inhaled or intravenous. The effectiveness of inhaled magnesium is required to be compared
with the effectiveness of magnesium administered intravenously to determine the adequate procedure
of administration of the drugs to reduce the symptoms of acute asthma in children admitted to the
emergency department.

Research Question
What is the effectiveness of intravenous therapy in the relief of acute asthma symptoms for
children presenting in the emergency department?
Research Objectives
 To determine the effectiveness of magnesium administered intravenously in
comparison to inhaled magnesium in children admitted to the emergency department.
Methodology
To achieve this research objective, a systematic review of literature will be conducted on the
research question following extensive search strategies and protocols.
Search Strategy
To search literature relevant to the research question, three major medical databases will be
searched, including BioMed Central, PubMed Central and CINAHL. The primary goal of this
literature review is to gather highly reliable information on the research question to fulfil the
objective, and specific inclusion and exclusion criteria will determine whether the articles found in
the search results are adequate to be included in this study. The aforementioned medical databases
will be searched with the help of keywords, which includes children, emergency department,
intravenous therapy, intravenous magnesium, effectiveness, efficacy, acute asthma symptoms,
reduction, relief and pediatric patients. The use of Boolean operators will be ensured with the help of
the advanced search option available in the respective databases to be included between the
keywords for better search results. The Boolean operator ‘OR’ will be used to increase the count of
articles appearing in the search results and the Boolean operator ‘AND’ will be used to increase the
relevancy of the articles to the current research question,
Inclusion Criteria
A set of criteria will be used to filter the articles from the search results to be included in the
study. The primary inclusion criteria would be the selection of only peer-reviewed articles for further

evaluation and synthesis of information. Only the articles published between the years 2010 to 2019
will be made available for further selection. The language of publication should be English only. No
geographical limitation to the research articles will be done to increase the generalisability of the
results, ensuring it supports global compatibility. The articles fulfilling the above-said criteria will be
then reviewed and selected based on the level of evidence
Exclusion Criteria
To increase the relevancy of the search results, a set of exclusion criteria will be followed.
This will ensure greater reliability and validity of the researched data. The primary exclusion criteria
include the exclusion of editorial letters, opinion papers and unpublished articles, which will not be
selected for further synthesis of information.
Selection of studies
Abstract and title screening was done to mark the relevant studies, and the Critical Appraisal
Skills Programme (CASP) checklist was used to critically appraise the selected studies and
determine their overall validity and reliability, to be used in this systematic review of literature on
the effectiveness of intravenous therapy in providing relief to acute asthma symptoms to children
admitted in the emergency department.
From a total of 849 articles that appeared in the search results post-application of search
protocols, inclusion criteria and exclusion criteria, five articles were chosen for the final review after
they were critically appraised with the help of CASP checklist.

Figure 1: PRISMA Flow Chart depicting the Identification and Selection of studies
Records identified through
medical database searching
(n = 849)
Sc
re
en
in
g
In
cl
ud
ed
El
igi
bil
ity
Id
en
tif
ic
ati Additional records identified
through other sources
(n = 202)
Records after duplicates removed
(n = 643)
Records screened
(n = 112)
Records excluded
(n = 531)
Full-text articles assessed for eligibility post
analysing with CASP checklist Tool
(n = 35)
Full-text articles
excluded,
(n = 78)
Studies included for final
synthesis
(n = 5)

Quality Appraisal Table
Griffiths &
Kew
Ibrahim &
Elkolaly
Albuali Bittar &
Guerra
Sellers
Year of
Publication
2016 2017 2014 2012 2013
Study
Findings
Intravenous
magnesium
therapy for
children
presenting to
the ED
resulted in
reduced
hospital
admission.
Intravenous
injection of
magnesium
was more
effective than
nebulised
magnesium
and was
affordable.
Intravenous
magnesium is
effective and
safe
bronchodilator
therapy.
Intravenous
treatment in
children in the
emergency
department is
infrequent and
is concluded to
be safe and
effective in
children with
asthma.
Intravenous
routes are the
key measures
undertaken
when the
inhalation
route fails.
Relevance Highly
relevant
Moderately
relevant
Highly relevant Highly
relevant
Low relevancy
Validity The studies
selected for
review were
published
between
1996 to 2000,
decreasing
the overall
validity of
the study
findings.
High validity
with a
detailed
methodology
for the
conduct of
the study.
The
methodology
for the
systematic
review was
comprehensive
.
The inclusion
criteria ensure
the latest
published
articles and
data.
The study
provides a
comprehensive
review of all
treatment
strategies for
asthma and is
not limited to
analysing the
effectiveness
of intravenous
therapy in
children
presented to
the emergency
department.
Reliability The
reliability of
the research
findings is
low.
High
reliability
High reliability The research
findings are
reliable with
comprehensive
details.
The research
findings are
broad and
reliable;
however,
minimal data I
available
relevant to the
current
research
question.

Summary Table
Name of the Author’s Study Design Initial Details of the Study
Griffiths & Kew (2016) Review of Literature Review of 5 studies to
compare the intravenous
magnesium infusion with
placebo infusion and
determine the efficacy of the
former method.
Ibrahim & Elkolaly (2017) Randomised Control Trial The study aimed to compare
the effect of magnesium
sulfate via nebulization and
intravenous injection on
bronchodilation and
controlling symptoms of
acute asthma.
Albuali (2014) Systematic Review The primary aim of the
study was to assess the
effectiveness of inhaled and
intravenous administration
of magnesium on children
for the management of
asthma.
Bittar & Guerra (2012) Systematic Review Determine the efficacy of
the use of magnesium
administered intravenously

in children with asthma
presented in the emergency
department.
Sellers (2013) Narrative Review Determine the efficiency
difference between
intravenous and inhaled
treatment methods in severe
acute asthma.
Summary of the Articles
The research study conducted by Griffiths & Kew (2016) was a review of literature in which
the researchers reviewed five studies to compare the intravenous magnesium infusion with placebo
infusion and determine the efficacy of the former method. The five studies included 182 children,
and the studies were published between 1996 and 2000. The key finding from the study is that
intravenous therapy for children presenting to the ED resulted in reduced hospital admission.
The research study conducted by Ibrahim & Elkolaly, (2017) was based upon a study design
of randomised control trial, with the objective of the study was to compare the effect of magnesium
sulfate via nebulization and intravenous injection on bronchodilation and to control of symptoms of
acute asthma. The participants were grouped to form to trail groups, one for intravenous injection
and the other for nebulization trial. According to the research findings, the use of intravenous
injection of magnesium was more effective than nebulised magnesium, where the former showed
clinical and beneficial improvements and the latter showed minimal improvements. One of the
fundamental limitation of this study in accordance to the current research question is that its
inclusion criteria for selection of participants is too broad and is not limited to only children as the

current research question intends to. Furthermore, very few participants were selected, which may
reduce the reliability of the research findings.
A systematic review of literature was conducted by Albuali (2014) with the primary objective
of the study was to assess the effectiveness of inhaled and intravenous magnesium sulfate on
children for management of asthma. The methodology for the systematic review was comprehensive.
The study concludes that intravenous magnesium is an effective and safe bronchodilator therapy,
whereas further investigation was required to assess the role of nebulised magnesium sulfate. The
research findings state that intravenous therapy was more effective in achieving early improvements
in the signs and symptoms of asthma.
Another systematic review conducted by Bittar & Guerra (2012) aimed to determine the
efficacy of the use of intravenous magnesium sulfate in children with asthma presented in the
emergency department. The inclusion criteria ensure the latest published articles and data. From the
research findings, it can be stated that intravenous treatment in children in the emergency department
is infrequent, and is concluded to be safe and effective in children with acute asthma.
Sellers (2013) conducted a narrative review of the literature intending to determine the
efficiency difference between intravenous and inhaled treatment methods in severe acute asthma.
According to the researcher, intravenous routes are the key measures undertaken when the inhalation
route fails. However, the research study provides a comprehensive review of all the measures of
treatment for acute asthma and thus, is not limited to the sample group of children presented to the
emergency department. This reduces the relevancy of the article with the research question; however,
the research findings are still reliable and can be used to determine conclusions.
Conclusion
Out of the five selected articles post-application of search protocols and critical appraisal, the
research study by Ibrahim & Elkolaly, (2017), Bittar & Guerra (2012) and Albuali (2014) can be
adjudged as the most appropriate journal papers for review as they are highly relevant to the current

research question, are from the top tiers in the level of evidence and have high reliability and
validity. From the general overview and synthesis of information gathered from the selected articles,
it can be concluded that intravenous therapy was deemed to be more effective in achieving clinical
improvements in the symptoms of acute asthma in children presented to the emergency department.