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Children 2018, 5(2), 17; https://doi.org/10.3390/children5020017

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

1
Division of Pediatric Emergency Medicine, Mease Countryside Hospital, Safety Harbor, FL 34695, USA
2
Medical Affairs, Virology, Merck & Co., Inc., Marietta, GA 30067, USA
3
Joe DiMaggio Children’s Hospital, Memorial Health Care, Hollywood, FL 33021, USA
4
Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
5
Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
ormerly: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Louisville, Louisville, KY 40202, USA.
Formerly: University of Louisville School of Public Health Information Sciences, Louisville, KY 40202, USA.
*
Author to whom correspondence should be addressed.
Received: 16 September 2017 / Revised: 31 December 2017 / Accepted: 4 January 2018 / Published: 29 January 2018
(This article belongs to the Section Oncology and Hematology)
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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. View Full-Text
Keywords: sickle cell disease; pain crisis; electrical cardiometry; near-infrared spectroscopy sickle cell disease; pain crisis; electrical cardiometry; near-infrared spectroscopy
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Padmanabhan, P.; Oragwu, C.; Das, B.; Myers, J.A.; Raj, A. 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. Children 2018, 5, 17.

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