{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:17:40Z","timestamp":1787962660019,"version":"build-2784847793"},"reference-count":42,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pediatric critical asthma is one of the most common pediatric illnesses in children admitted to the pediatric ward and pediatric intensive care unit (PICU). Adjunct intravenous (IV) bronchodilators are often used when initial management with systemic corticosteroids and inhaled short\u2010acting beta agonists (SABA) fail to provide improvement in a patient's clinical condition. While the recent guidelines gave recommendations for the use of different IV bronchodilators compared to placebo, it did not include ranking on which one should be used as first\u2010line or second\u2010line agent. The aim of this network meta\u2010analysis is to determine the effect of IV bronchodilators on patient\u2010centered outcomes and rank medications based on their effectiveness in these outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic review was conducted using three databases MEDLINE, Embase, and CINAHL to identify randomized control trials examining the use of IV magnesium sulfate (MgSO\n                      <jats:sub>4<\/jats:sub>\n                      ), IV methylxanthines (aminophylline or theophylline), IV SABA (salbutamol, terbutaline) in pediatric critical asthma patients. Bayesian network metanalytic framework was used to compare the interventions. Results are reported as odds ratio (OR) or mean difference (MD) and 95% Credible Interval (CrI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twelve trials (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009852) were included in the network meta\u2010analysis. Largest reduction in hospital length of stay (LOS), PICU admission, and PICU LOS were noted with IV MgSO\n                      <jats:sub>4<\/jats:sub>\n                      ; (MD: \u22123.1 days, 95% CrI: \u22126.9 days to 0.13 days), (OR 0.21; 95% CrI 0.02, 1.3), and (MD: \u22124.0 days, 95% CrI: \u22127.1 days to \u22121.2 days) respectively. IV MgSO\n                      <jats:sub>4<\/jats:sub>\n                      was ranked first in three outcomes of interest with Surface Under the Cumulative Ranking curve (SUCRA) of 0.884 for hospital LOS, 0.919 for PICU admission, and 0.957 for PICU LOS. For preventing intubation, IV SABA was ranked the highest (SUCRA 0.995), but the only study with IV SABA had zero intubation events. In a sensitivity analysis that excluded studies with zero events, the intubation rate was lowest with IV MgSO\n                      <jats:sub>4<\/jats:sub>\n                      (OR 0.10; 95% CrI 0.003, 0.88) and it was ranked the best treatment (SUCRA 0.921).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In this network meta\u2010analysis comparing different IV adjunct bronchodilators, IV MgSO\n                      <jats:sub>4<\/jats:sub>\n                      was ranked first followed by IV SABA, and then IV methylxanthines. Given these findings and the favorable safety profile, ease of use, and low cost, IV MgSO\n                      <jats:sub>4<\/jats:sub>\n                      appears most promising the first adjunct IV bronchodilator, however, further large high\u2010quality trials are still needed before it can be endorsed as routine first\u2010line agent.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71192","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T12:41:14Z","timestamp":1752151274000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Intravenous Bronchodilators in Pediatric Critical Asthma: A Systematic Review and Network Meta\u2010Analysis"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2659-2070","authenticated-orcid":false,"given":"Samer","family":"Abu\u2010Sultaneh","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9110-9156","authenticated-orcid":false,"given":"Andrew G.","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine Duke University Medical Center Durham North Carolina USA"},{"name":"Respiratory Care Services, Duke University Medical Center Durham North Carolina USA"},{"name":"Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0657-8386","authenticated-orcid":false,"given":"Sangita","family":"Basnet","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics Southern Illinois University School of Medicine Springfield Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1701-3655","authenticated-orcid":false,"given":"Hannah J.","family":"Craven","sequence":"additional","affiliation":[{"name":"Ruth Lilly Medical Library, Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1198-1129","authenticated-orcid":false,"given":"Abdallah","family":"Dalabih","sequence":"additional","affiliation":[{"name":"Driscoll Children's Health System Corpus Christi Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7216-2005","authenticated-orcid":false,"given":"Jose Enrique","family":"Irazuzta","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine University of Florida Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine A.","family":"Kapuscinski","sequence":"additional","affiliation":[{"name":"Department of Pharmacy John R. 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L.","family":"Newth","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles University of Southern California Keck School of Medicine Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4452-4488","authenticated-orcid":false,"given":"Sana J.","family":"Said","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Comer Children's Hospital University of Chicago Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0103-6318","authenticated-orcid":false,"given":"Elizabeth C.","family":"Whipple","sequence":"additional","affiliation":[{"name":"Welch Medical Library Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0826-1171","authenticated-orcid":false,"given":"Lynda T.","family":"Goodfellow","sequence":"additional","affiliation":[{"name":"Section Editor\u2010Respiratory Care, Irving, Texas Georgia State University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9237-0185","authenticated-orcid":false,"given":"Benjamin R.","family":"White","sequence":"additional","affiliation":[{"name":"UT Department of Pediatrics, Division of Pediatric Critical Care Medicine University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3589-0018","authenticated-orcid":false,"given":"Narayan Prabhu","family":"Iyer","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Keck School of Medicine, Fetal and Neonatal Institute, Children's Hospital Los Angeles University of Southern California Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-018-0726-2"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05174"},{"issue":"6","key":"e_1_2_11_4_1","first-page":"746","article-title":"Pharmacological Management of Pediatric Critical Asthma","volume":"70","author":"Rogerson C. 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