Management of an acute painful sickle cell episode in hospital: summary of NICE guidance

Gillis, V. L.; Senthinathan, A.; Dzingina, Mendwas; Chamberlain, Katie H.; Banks, Emily; Baker, Mark; Longson, Damien

doi:10.1136/bmj.e4063

Cited by 18 publications

(14 citation statements)

References 6 publications

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“…There was no evidence of an increased risk of ACS. The time to first analgesia was well within the standards of the NICE and NHLBI guidelines [6,7], and compares very favorably with the time to analgesia reported in studies of adult and paediatric ED departments in the USA [2,4,5,14]. Delays in obtaining intravenous access were avoided, and ED nursing staff could be trained to prepare and administer IND very rapidly.…”

Section: Discussionsupporting

confidence: 56%

“…Delays in triaging, clinical assessment, and administering analgesia in emergency department (ED) result in sub-optimal pain management and might be associated with increasing pain levels with a prolonged duration of the episode and hospital admission [2,3,4,5]. In 2012, the National Institute of Health Care Excellence (NICE) in the UK published an evidence-based guideline in 2012, recommending that the first dose of strong opioid analgesia should be given within 30 min of presentation [6]. An National Heart, Lung and Blood Institute (NHLBI) guideline in the USA, published in 2014, recommended that the first dose should be given within 30 min of triage and within 60 min of the first presentation [7].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a Non-Parenteral Opioid Analgesia Protocol for Acute Sickle Cell Pain Episodes in Children

Telfer

Barroso

Newell

et al. 2019

JCM

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We evaluated a protocol comprising intranasal diamorphine (IND) combined with oral short and modified-release morphine for children at the emergency department (ED) with acute painful episodes of sickle cell disease (SCD). In a retrospective audit of 83 episodes in 38 children, the mean time between arrival in the treatment area and the administration of IND was 10 min (range <5 min to 1.39 h). IND was administered in <5 min in 43 (51.6%), and in <20 min in 75 (90.4%) episodes. Persisting pain, requiring background analgesia with modified-release oral morphine, was required in 25 (30.1%) episodes. Inadequate control of pain requiring a switch to intravenous morphine PCA was required in eight episodes in four patients. Acute chest syndrome (ACS) developed in four of 83 episodes (4.8%, 95% CI 0.2–9.4%) and in four of 38 children (10.5%, 95% CI 0.7–20.5%). In conclusion, this protocol enabled the rapid administration of strong opioid analgesia in an ED setting, and may reduce the short and long-term adverse effects associated with parenteral opioids in children. There was no evidence of an increased incidence of ACS associated with use of oral morphine.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Evaluation of a Non-Parenteral Opioid Analgesia Protocol for Acute Sickle Cell Pain Episodes in Children

Telfer

Barroso

Newell

et al. 2019

JCM

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“…Severe pain usually lasts one to five days, with full recovery after one week, but this varies widely. Severe pain is usually managed in hospital with opiates, as recommended by National Institute for Health and Care Excellence guidelines 17…”

Section: Painmentioning

confidence: 99%

Management of sickle cell disease in the community

Brousse

Makani

Rees

2014

BMJ

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“…However, these pain measurements are subjective and unquantifiable. 6 There is a urgent need for convenient tools for monitoring and prediction of the vaso-occlusive pain, as well as patient's therapeutic outcomes. Existing laboratory techniques for monitoring SCD used in hospital include hemoglobin electrophoresis, isoelectric focusing, and cation-exchange high-performance liquid chromatography, require sophisticated equipment, special reagents and complicated procedures.…”

Section: Introductionmentioning

confidence: 99%

Electrical impedance detection of sickle cell vaso-occlusion in microfluidic capillary structures

Qiang¹,

Liu²,

Dieujuste³

et al. 2020

Preprint

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Sickle cell disease (SCD) is primarily associated with episodic vaso-occlusive events. Poorly deformable sickle cells may get stuck in small blood vessels, slow down or block blood flow, leading to local hypoxia that damages tissues and organs. In this paper, we present a novel electrical impedance sensing technique for detection of the progressive occlusion by sickle cells in microfluidic capillary structures. Changes in both resistance and reactance of the sickle blood flow were observed at multiple low frequencies (< 500 kHz), upon the deoxygenation and reoxygenation processes. In contrast, no obvious impedance changes were observed in the flow of normal blood cells and sickle blood cells treated with anti-sickling agent. Accuracy of the impedance-based detection of the vaso-occlusion process was verified by microscopic observation. The results show the distinct sensing performance of sickle cell vaso-occlusion by electrical impedance, which does not require sophisticated optical microscopy or video processing. The low frequency impedance sensing can be achieved by replacing the benchtop equipment with low-cost, high precision impedance converter system, allowing for detection of sickle cell vaso-occlusion in point-of-care settings.

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Management of an acute painful sickle cell episode in hospital: summary of NICE guidance

Cited by 18 publications

References 6 publications

Evaluation of a Non-Parenteral Opioid Analgesia Protocol for Acute Sickle Cell Pain Episodes in Children

Evaluation of a Non-Parenteral Opioid Analgesia Protocol for Acute Sickle Cell Pain Episodes in Children

Management of sickle cell disease in the community

Electrical impedance detection of sickle cell vaso-occlusion in microfluidic capillary structures

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