Fluid replacement therapy for acute episodes of pain in people with sickle cell disease

Okomo, UA; Meremikwu, MM

doi:10.1002/14651858.cd005406

Cited by 6 publications

(9 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evidence regarding the best volume and route of administration of FT is lacking. 14 In the Netherlands, for paediatric patients, a total fluid intake (oral + IV NaCl 0Á45%/glucose 2Á5%) of 3 l/m 2 /24 h is recommended. Adult patients are treated with 3 l IV fluids/24 h. The IV fluid is tapered or stopped after 72 h. A comparison of treatment protocols in 25 institutions in the USA found more modest fluid regimens, varying from no IV fluids to administration of 1Á59 maintenance volume or greater IV, which is calculated based on body weight.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fluid overload due to intravenous fluid therapy for vaso‐occlusive crisis in sickle cell disease: incidence and risk factors

et al. 2021

View full text Add to dashboard Cite

Intravenous fluid therapy (IV-FT) is routinely used in the treatment of vasoocclusive crises (VOCs), as dehydration possibly promotes and sustains erythrocyte sickling. Patients with sickle cell disease (SCD) are at risk of developing diastolic dysfunction and fluid overload due to IV-FT. However, data on the adverse effects of IV-FT for VOC is sparse. We aimed to evaluate the incidence and risk factors of fluid overload due to IV-FT in patients with SCD. Consecutive hospitalisations for VOC treated with IV-FT between September 2016 and September 2018 were retrospectively analysed. The median (interquartile range) age was 25Á0 (18Á3-33Á8) years and 65% had a severe genotype (HbSS/HbSb 0 -thal). Fluid overload occurred in 21% of 100 patients. Hospital stay was longer in patients with fluid overload (6Á0 vs. 4Á0 days, P = 0Á037). A positive history of fluid overload (P = 0Á017), lactate dehydrogenase level (P = 0Á011), and top-up transfusion during admission (P = 0Á005) were independently associated with fluid overload occurrence. IV-FT was not reduced in 86% of patients despite a previous history of fluid overload. Fluid overload is frequently encountered during IV-FT for VOC. IV-FT is often not adjusted despite a positive history of fluid overload or when top-up transfusion is indicated, emphasising the need for more awareness of this complication and a personalised approach.

show abstract

Section: Discussionmentioning

confidence: 99%

“…As a result, there is no clear consensus on the amount, rate and type of the administered fluids. 14 Consequently, IV-FT for VOC is more experience-than evidencebased, resulting in inconsistency in treatment protocols.…”

Section: Introductionmentioning

confidence: 99%

Fluid overload due to intravenous fluid therapy for vaso‐occlusive crisis in sickle cell disease: incidence and risk factors

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The use of IVF in the treatment of SCD-related acute pain in the ED is in clinical equipoise and the recent NHLBI guidelines lack firm guidance for how providers should administer IVF, if at all, in this clinical scenario. 7 Emphasis regarding IV hydration in the published guidelines focuses on the hypovolemic patient, 3,15 however clinical practice appears to have extended this to the majority of patients. Specifically, the NHLBI guidelines state "in euvolemic adults and children with SCD and VOE who are unable to drink fluids, provide intravenous hydration at no more than maintenance rate to avoid over-hydration.…”

Section: Discussionmentioning

confidence: 99%

“…2 Treatment of VOE commonly includes analgesics and intravenous fluids (IVFs). [3][4][5] However, evidence for utilizing IVF in euvolemic patients or guiding the clinicians' choice for IVFs is lacking, [3][4][5] has changed little over the last decade, [6][7][8] and was not adequately addressed by recent National Heart, Lung, and Blood Institute (NHLBI) guidelines on SCD management. 3 The historical use of saline for intravenous resuscitation dates to early 19th-century Britain during the cholera epidemic.…”

Section: Funding Informationmentioning

confidence: 99%

Normal saline bolus use in pediatric emergency departments is associated with poorer pain control in children with sickle cell anemia and vaso‐occlusive pain

et al. 2019

View full text Add to dashboard Cite

Vaso‐occlusive pain events (VOE) are the leading cause of emergency department (ED) visits in sickle cell anemia (SCA). This study assessed the variability in use of intravenous fluids (IVFs), and the association of normal saline bolus (NSB), on pain and other clinical outcomes in children with SCA, presenting to pediatric emergency departments (PED) with VOE. Four‐hundred charts of children age 3‐21 years with SCA/VOE receiving parenteral opioids at 20 high‐volume PEDs were evaluated in a retrospective study. Data on type and amount of IVFs used were collected. Patients were divided into two groups: those who received NSB and those who did not. The association of NSB use on change in pain scores and admission rates was evaluated. Among 400 children studied, 261 (65%) received a NSB. Mean age was 13.8 ± 4.9 years; 46% were male; 92% had hemoglobin‐SS. The IVFs (bolus and/or maintenance) were used in 84% of patients. Eight different types of IVFs were utilized and IVF volume administered varied widely. Mean triage pain scores were similar between groups, but improvement in pain scores from presentation‐to‐ED‐disposition was smaller in the NSB group (2.2 vs 3.0, P = .03), while admission rates were higher (71% vs 59%, P = .01). Use of NSB remained associated with poorer final pain scores and worse change in pain scores in our multivariable model. In conclusion, wide variations in practice utilizing IVFs are common. NSB is given to >50% of children with SCA/VOE, but is associated with poorer pain control; a controlled prospective trial is needed to determine causality.

show abstract

“…12,13,32 Respiratory AEs occurred in a bimodal fashion with a large peak on Most notably, patients with FO were more likely, regardless of the time frame and controlling for infection status, to develop a respiratory AE during the induction phase. In other pediatric conditions such as sepsis, 33,34 acute renal failure, 35 sickle cell disease, [36][37][38] and asthma, 39 FO status is known to be associated with respiratory AE development, deterioration, and poor outcomes. 40 Several diagnostic and management strategies for prevention, early diagnosis, and treatment of FO have been previously studied and may be relevant to our population.…”

Section: Discussionmentioning

confidence: 99%

Impact of fluid overload and infection on respiratory adverse event development during induction therapy for childhood acute myeloid leukemia

Miller

Keller

Mertens

et al. 2019

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Background Treatment‐related morbidity and mortality occur frequently in childhood acute myeloid leukemia (AML) induction. Yet the contributions of respiratory adverse events (AEs) within this population are poorly understood. Furthermore, the roles of fluid overload (FO) and infection in AML pulmonary complications have been inadequately examined. Objectives To describe the incidence, categories, and grades of respiratory AEs and to assess the associations of FO and infection on respiratory AE development in childhood AML induction. Methods We retrospectively examined the induction courses of a cohort of de novo pediatric AML patients for any NCI CTCAE grade 2 to 5 respiratory AE, FO, and systemic/pulmonary infection occurrence. Demographic, disease, and treatment‐related data were abstracted. Descriptive, univariate, survival, and multivariable analyses were conducted. Results Among 105 eligible subjects from 2009 to 2016, 49.5% (n = 52) experienced 63 discrete respiratory AEs. FO occurred in 28.6% of subjects (n = 30), with half occurring within 24 hours of hospitalization. Positive FO status < 10 days (aHR 5.5, 95% CI 2.3‐12.8), ≥ 10 days (aHR 13, 95% CI 4.1‐41.8), and positive infection status ≥ 10 days into treatment (aHR 14.9, 5.4‐41.6) were each independently associated with AE development. Conclusions We describe a higher incidence of respiratory AEs during childhood AML induction than previously illustrated. FO occurs frequently and early in this course. Late infections and FO at any time frame were strongly associated with AE development. Interventions focused on the prevention and management of FO and infectious respiratory complications could be instrumental in reducing preventable treatment‐related morbidity and mortality.

show abstract

Fluid replacement therapy for acute episodes of pain in people with sickle cell disease

Abstract: Fluid replacement therapy for acute episodes of pain in people with sickle cell disease.

Cited by 6 publications

References 12 publications

Fluid overload due to intravenous fluid therapy for vaso‐occlusive crisis in sickle cell disease: incidence and risk factors

Fluid overload due to intravenous fluid therapy for vaso‐occlusive crisis in sickle cell disease: incidence and risk factors

Normal saline bolus use in pediatric emergency departments is associated with poorer pain control in children with sickle cell anemia and vaso‐occlusive pain

Impact of fluid overload and infection on respiratory adverse event development during induction therapy for childhood acute myeloid leukemia

Contact Info

Product

Resources

About