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Inpatient management of sickle cell pain: a 'snapshot' of current practice. Am J Hematol 2012 Mar;87(3):333-6

Date

01/11/2012

Pubmed ID

22231150

Pubmed Central ID

PMC5047515

DOI

10.1002/ajh.22265

Scopus ID

2-s2.0-84862777383   28 Citations

Abstract

The Sickle Cell Disease Clinical Research Network (SCDCRN) designed the PROACTIVE Feasibility Study (ClinicalTrials.gov NCT00951808) to determine whether elevated serum levels of secretory phospholipase A2 (sPLA2) during hospitalization for pain would permit preemptive therapy of sickle cell acute chest syndrome (ACS) by blood transfusion. While PROACTIVE was not designed to assess pain management and was terminated early due to inadequate patient accrual, collection of clinical data allowed a "snapshot" of current care by expert providers. Nearly half the patients admitted for pain were taking hydroxyurea; hydroxyurea did not affect length of stay. Providers commonly administered parenteral opioid analgesia, usually morphine or hydromorphone, to adults and children, generally by patient-controlled analgesia (PCA). Adult providers were more likely to prescribe hydromorphone and did so at substantially higher morphine equivalent doses than were given to adults receiving morphine; the latter received doses similar to children who received either medication. All subjects treated with PCA received higher daily doses of opioids than those treated by time-contingent dosing. Physicians often restricted intravenous fluids to less than a maintenance rate and underutilized incentive spirometry, which reduces ACS in patients hospitalized for pain.

Author List

Miller ST, Kim HY, Weiner D, Wager CG, Gallagher D, Styles L, Dampier CD, Investigators of the Sickle Cell Disease Clinical Research Network (SCDCRN)

Author

Deepak Kilari MD Associate Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Acute Chest Syndrome
Adolescent
Adult
Aged
Analgesia, Patient-Controlled
Anemia, Sickle Cell
Blood Transfusion
Child
Child, Preschool
Combined Modality Therapy
Drug Utilization
Feasibility Studies
Female
Fluid Therapy
Humans
Hydroxyurea
Inpatients
Male
Middle Aged
Narcotics
Oxygen Inhalation Therapy
Pain
Practice Patterns, Physicians'
Pulmonary Edema
Randomized Controlled Trials as Topic
Retrospective Studies
Spirometry
Young Adult