Utility of Non-Invasive Monitoring of Cardiac Output and Cerebral Oximetry during Pain Management of Children with Sickle Cell Disease in the Pediatric Emergency Department.

Pradeep Padmanabhan,Chikelue Oragwu,John Myers,Ashok Raj,Bibhuti Das

doi:10.3390/children5020017

Abstract

Pain crisis in children with sickle cell disease (SCD) is typically managed with intravenous fluids and parenteral opioids in the pediatric emergency department. Electrical cardiometry (EC) can be utilized to measure cardiac output (CO) and cardiac index (CI) non-invasively. Near-infrared spectroscopy (NIRS) measuring cerebral (rCO2) and splanchnic regional (rSO2) mixed venous oxygenation non-invasively has been utilized for monitoring children with SCD. We studied the value and correlation of NIRS and EC in monitoring hemodynamic status in children with SCD during pain crisis. We monitored EC and NIRS continuously for 2 h after presentation and during management. Forty-five children participated in the study. CO (D = 1.72), CI (D = 1.31), rSO2 (D = 11.6), and rCO2 (D = 9.3), all increased over time. CO max and CI max were achieved 1 h after starting resuscitation. rCO2 max attainment was quicker than rSO2, as monitored by NIRS. CI max correlated with rCO2 max (r = −0.350) and rSO2 max (r = −0.359). In adjustment models, initial CI significantly impacted initial rCO2 (p = 0.045) and rCO2 max (p = 0.043), while initial CO impacted rCO2 max (p = 0.030). Cardiac output monitoring and NIRS monitoring for cerebral and splanchnic oxygenation were feasible and improved the monitoring of therapeutic interventions for children with SCD during pain crisis.

Highlights

IntroductionPain crises account for 79–91% of pediatric emergency department (PED) visits and up to 70%
Pain crises account for 79–91% of pediatric emergency department (PED) visits and up to 70%of hospitalizations in patients with sickle cell disease (SCD) [1]
The current study aimed to examine the impact of IV fluids and parenteral opioids on cardiac output (CO), cardiac index (CI) and oxygenation, over time, for pediatric SCD patients experiencing a pain crisis

Summary

Introduction

Pain crises account for 79–91% of pediatric emergency department (PED) visits and up to 70%. Research and Quality reported that nearly 80% of the 80,000 hospital admissions for SCD began their course in the emergency department (ED) [2,3]. Treatment for pain crisis in the ED typically consists of intravenous (IV) fluid hydration and analgesia to provide prompt symptomatic relief. There are caveats to conventional measurements, such as pulse-oximetry (dependent on hemoglobin levels which are decreased and vary in SCD), and the typical tachycardia in pain crisis could be compounded by factors such as anemia and pain, and may not be attributable to dehydration alone. While the complications of the management of children with pain crisis from SCD are low in a carefully controlled, monitored setting, additional focused monitoring may provide useful information

Methods

Results

Conclusion