Inpatient management of sickle cell pain: a 'snapshot' of current practice
Scott T Miller, Hae-Young Kim, Debra Weiner, Carrie G Wager, Dianne Gallagher, Lori Styles, Carlton D Dampier, Investigators of the Sickle Cell Disease Clinical Research Network (SCDCRN), Peter A Lane, Tamara N New, Terrell Faircloth, Matthew M Heeney, Natasha Soodoo, Meredith Anderson, Lillian E C McMahon, Asif I Qureshi, Maureen Okam, Kwaku Ohene-Frempong, Kim Smith-Whitley, Norma B Lerner, Michele Cahill, MaryLou MacDermott, Maureen Meier, Robin Miller, Lynn Marrs, Salvatore Bertolone, Ashok B Raj, Victor R Gordeuk, Oswaldo L Castro, Lewis L Hsu, Richard J Labotka, Robert Molokie, Sandra Gooden, Daisy Pacelli, Lani Krauz, Alexis A Thompson, Wally R Smith, Kamar Godder, Susan D Roseff, James F Casella, Jeffrey Keefer, Sophie Lanzkron, Cedron Williams, Phillip Seaman, Kenneth I Ataga, Susan K Jones, Dell Strayhorn, Teresa Etscovitz, Rathi V Iyer, Mary Gail Smith, Carolyn Bigelow, Suvankar Majumdar, Glenda Thomas, Arleen Anderson, Abdullah Kutlar, Leigh Wells, Latanya Bowman, Pritam Bora, Paul Swerdlow, Marilyn J Telen, Laura M De Castro, Shital Kamble, Shelby Reed, Courtney D Thornburg, Hai Huang, Jude Jonassaint, Rita Bellevue, Emmely M Colon, Herold Duroseau, Deepak Kilari, Charlene Webb, Edouard Guillaume, Rafat Ahmed, Miren Blackwood, Huguette Souffrant, Hossam Awad, Karen Kalinyak, Clinton H Joiner, Eric H Kraut, Leslie Witkoff, Melissa M Rhodes, Kami Perdue, Sonja M McKinlay, Beatrice Files, Liyuan Huang, David Brazier, Kristin K Snow, Margaret C Bell, Harvey Luksenburg, Henry Chang, Liana Harvath, Myron Waclawiw, Erin Smith, Ellen M Werner, Ted Wun, Amy Becker, Lennette Benjamin, Susan Claster, Michael Farrell, Allison A King, Jeannette Y Lee, Robert P McMahon, Julie A Panepinto, Scott T Miller, Hae-Young Kim, Debra Weiner, Carrie G Wager, Dianne Gallagher, Lori Styles, Carlton D Dampier, Investigators of the Sickle Cell Disease Clinical Research Network (SCDCRN), Peter A Lane, Tamara N New, Terrell Faircloth, Matthew M Heeney, Natasha Soodoo, Meredith Anderson, Lillian E C McMahon, Asif I Qureshi, Maureen Okam, Kwaku Ohene-Frempong, Kim Smith-Whitley, Norma B Lerner, Michele Cahill, MaryLou MacDermott, Maureen Meier, Robin Miller, Lynn Marrs, Salvatore Bertolone, Ashok B Raj, Victor R Gordeuk, Oswaldo L Castro, Lewis L Hsu, Richard J Labotka, Robert Molokie, Sandra Gooden, Daisy Pacelli, Lani Krauz, Alexis A Thompson, Wally R Smith, Kamar Godder, Susan D Roseff, James F Casella, Jeffrey Keefer, Sophie Lanzkron, Cedron Williams, Phillip Seaman, Kenneth I Ataga, Susan K Jones, Dell Strayhorn, Teresa Etscovitz, Rathi V Iyer, Mary Gail Smith, Carolyn Bigelow, Suvankar Majumdar, Glenda Thomas, Arleen Anderson, Abdullah Kutlar, Leigh Wells, Latanya Bowman, Pritam Bora, Paul Swerdlow, Marilyn J Telen, Laura M De Castro, Shital Kamble, Shelby Reed, Courtney D Thornburg, Hai Huang, Jude Jonassaint, Rita Bellevue, Emmely M Colon, Herold Duroseau, Deepak Kilari, Charlene Webb, Edouard Guillaume, Rafat Ahmed, Miren Blackwood, Huguette Souffrant, Hossam Awad, Karen Kalinyak, Clinton H Joiner, Eric H Kraut, Leslie Witkoff, Melissa M Rhodes, Kami Perdue, Sonja M McKinlay, Beatrice Files, Liyuan Huang, David Brazier, Kristin K Snow, Margaret C Bell, Harvey Luksenburg, Henry Chang, Liana Harvath, Myron Waclawiw, Erin Smith, Ellen M Werner, Ted Wun, Amy Becker, Lennette Benjamin, Susan Claster, Michael Farrell, Allison A King, Jeannette Y Lee, Robert P McMahon, Julie A Panepinto
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.
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Source: PubMed