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Khalaf Z, Mahmood M. Acute chest syndrome in post-operative sickle cell disease patients: a systematic review of predisposing factors and interventions. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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2
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Heilbronner C, Grimaud M, Oualha M, Sommet J, Rambaud J, Brousse V, Allali S, Renolleau S. Therapeutic approach to pediatric patients with acute chest syndrome: national multicenter survey of non invasive ventilation (NIV) and transfusion. Arch Pediatr 2021; 28:559-566. [PMID: 34400054 DOI: 10.1016/j.arcped.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/10/2021] [Accepted: 06/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intensive care units (ICUs) have seen a spike in the use of noninvasive ventilation (NIV) for many medical conditions. We sought to investigate the attitudes and clinical practice regarding the management of acute chest syndrome (ACS) with a focus on NIV in pediatric ICUs. METHOD Members of the French Group for Pediatric Intensive Care Emergencies (GFRUP) were asked to complete an online survey on physicians' attitudes toward children with ACS admitted to the PICU during 2015. RESULTS The survey was answered by teams from 17 PICUs (240 beds). In total, 15 centers (88%) had a local transfusion unit and 14 (82%) worked in connection with a sickle cell disease (SCD) reference center. During 2015, 360 patients with SCD were managed (median: 7 per center; 21) of whom 137 (38%) for an ACS (median: 4 ACS per center; 8). The median length of PICU stay for ACS was 5 days (3.1). Among the 137 patients who presented with ACS, 73 (53%) received simple blood transfusion and 16 (12%) received exchange transfusion. For patients who required noninvasive ventilatory support, NIV with bilevel pressure (BiPAP) was the most frequent method (n = 68, 50%), followed by continuous positive airway pressure (CPAP) (n = 23, 17%) and high-flow oxygen (n = 21, 15%). The proportion of patients on BiPAP was up to 71% in the centers most frequently managing ACS patients. CONCLUSION BiPAP is commonly used in PICUs for SCD patients with ACS, especially in trained centers. Future physiological studies and randomized controlled trials might help to choose the best ventilatory support for ACS.
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Affiliation(s)
- C Heilbronner
- AP-HP, Hôpital Necker Enfants Malades, Pediatric Intensive Care Unit, 149 rue de Sèvres, 75015 Paris, France.
| | - M Grimaud
- AP-HP, Hôpital Necker Enfants Malades, Pediatric Intensive Care Unit, 149 rue de Sèvres, 75015 Paris, France
| | - M Oualha
- AP-HP, Hôpital Necker Enfants Malades, Pediatric Intensive Care Unit, 149 rue de Sèvres, 75015 Paris, France
| | - J Sommet
- AP-HP, Hôpital Robert Debré, Pediatric Intensive Care Unit, 75019 Paris, France
| | - J Rambaud
- AP-HP, Hôpital Armand Trousseau, Pediatric Intensive Care Unit, 75012 Paris, France
| | - V Brousse
- AP-HP, Hôpital Necker Enfants Malades, Pediatric Department, 75015 Paris, France
| | - S Allali
- AP-HP, Hôpital Necker Enfants Malades, Pediatric Department, 75015 Paris, France
| | - S Renolleau
- AP-HP, Hôpital Necker Enfants Malades, Pediatric Intensive Care Unit, 149 rue de Sèvres, 75015 Paris, France
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Schyrr F, Dolci M, Nydegger M, Canellini G, Andreu‐Ullrich H, Joseph J, Diezi M, Cachat F, Rizzi M, Renella R. Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations. Am J Hematol 2020; 95:78-96. [PMID: 31456233 DOI: 10.1002/ajh.25626] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023]
Abstract
Children with sickle cell disease (SCD) require specific perioperative care, and clinical practice in this area remains poorly defined. We aimed to conduct a systematic, PRISMA-based review of the literature, available clinical guidelines and practice recommendations. We also aimed to extract any valuable information for the "best of available-evidence"-based prevention of perioperative adverse events in children with SCD, and highlight the most urgent priorities in clinical research. As data sources, US National Library of Medicine, Medline, National Guideline Clearinghouse, International Guideline Network, TRIP databases were searched for any content until January 2019. We also included institutional, consortia and expert group guidelines. Included were reports/guidelines in English, French, German, and Italian. Excluded were reports on obstetrical and fetal management. We identified 202 reports/guidelines fulfilling the criteria outlined above. A majority focused on visceral, cardiovascular and orthopedic surgery procedures, and only five were multicenter randomized controlled trials and two prospective randomized studies. After grading of the quality of the evidence, the extracted data was summarized into clinical recommendations for daily practice. Additionally, we designed a risk-grading algorithm to identify contexts likely to be associated with adverse outcomes. In conclusion, we provide a systematic PRISMA-based review of the existing literature and ancillary practice and delineate a set of clinical recommendations and priorities for research.
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Affiliation(s)
- Frederica Schyrr
- Pediatric Hematology‐Oncology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Mirko Dolci
- Division of Anesthesia, Department of SurgeryLausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Martine Nydegger
- Division of Anesthesia, Department of SurgeryLausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Giorgia Canellini
- Transfusion Medicine Unit, Department of Laboratory MedicineLausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Heidrun Andreu‐Ullrich
- Transfusion Medicine Unit, Department of Laboratory MedicineLausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Jean‐Marc Joseph
- Division of Pediatric Surgery, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Manuel Diezi
- Pediatric Hematology‐Oncology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Francois Cachat
- Pediatric Nephrology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Mattia Rizzi
- Pediatric Hematology‐Oncology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Raffaele Renella
- Pediatric Hematology‐Oncology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
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Howard J, Lee SA, Inusa B, Cheng MYE, Bavenjit C, Reading IC, Wakeford SA, Gavlak JC, Murphy PB, Hart N, Gupta A, Sahota S, Jacob E, Chorozoglou M, Ossai C, Gwam M, Kirkham FJ, Wade AM, Liossi C. Prevention of Morbidity in Sickle Cell Disease (POMS2a)-overnight auto-adjusting continuous positive airway pressure compared with nocturnal oxygen therapy: a randomised crossover pilot study examining patient preference and safety in adults and children. Trials 2019; 20:442. [PMID: 31319882 PMCID: PMC6637584 DOI: 10.1186/s13063-019-3461-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
DESIGN This randomised crossover trial compared nocturnal auto-adjusting continuous positive airway pressure (APAP) and nocturnal oxygen therapy (NOT) in adults and children with sickle cell anaemia, with patient acceptability as the primary outcome. Secondary outcomes included pulmonary physiology (adults), safety, and daily pain during interventions and washout documented using tablet technology. METHODS Inclusion criteria were age > 8 years and the ability to use an iPad to collect daily pain data. Trial participation was 4 weeks; week 1 involved baseline data collection and week 3 was a washout between interventions, which were administered for 7 days each during weeks 2 and 4 in a randomised order. Qualitative interviews were transcribed verbatim and analysed for content using a funnelling technique, starting generally and then gaining more detailed information on the experience of both interventions. Safety data included routine haematology and median pain days between each period. Missing pain day values were replaced using multiple imputation. RESULTS Ten adults (three female, median age 30.2 years, range 18-51.5 years) and eleven children (five female, median age 12 years, range 8.7-16.9 years) enrolled. Nine adults and seven children completed interviews. Qualitative data revealed that the APAP machine was smaller, easier to handle, and less noisy. Of 16 participants, 10 preferred APAP (62.5%, 95% confidence interval (CI) 38.6-81.5%). Haemoglobin decreased from baseline on APAP and NOT (mean difference -3.2 g/L (95% CI -6.0 to -0.2 g/L) and -2.5 g/L (95% CI -4.6 to 0.3 g/L), respectively), but there was no significant difference between interventions (NOT versus APAP, 1.1 (-1.2 to 3.6)). Pulmonary function changed little. Compared with baseline, there were significant decreases in the median number of pain days (1.58 for APAP and 1.71 for NOT) but no significant difference comparing washout with baseline. After adjustment for carry-over and period effects, there was a non-significant median difference of 0.143 (95% CI -0.116 to 0.401) days additional pain with APAP compared with NOT. CONCLUSION In view of the point estimate of patient preference for APAP, and no difference in haematology or pulmonary function or evidence that pain was worse during or in washout after APAP, it was decided to proceed with a Phase II trial of 6 months APAP versus standard care with further safety monitoring for bone marrow suppression and pain. TRIAL REGISTRATION ISRCTN46078697 . Registered on 18 July 2014.
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Affiliation(s)
- Jo Howard
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sophie A Lee
- Centre for Applied Statistics Courses, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Baba Inusa
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | | | - Isabel C Reading
- Research Design Service, University Hospital Southampton, Southampton, UK
| | - Sally Ann Wakeford
- Department of Child Health, University Hospital Southampton, Southampton, UK
| | - Johanna C Gavlak
- Department of Child Health, University Hospital Southampton, Southampton, UK.,Developmental Neurosciences Section and NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Patrick B Murphy
- King's College London, London, UK.,Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Hart
- King's College London, London, UK.,Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Sati Sahota
- Developmental Neurosciences Section and NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Eufemia Jacob
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Maria Chorozoglou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Carol Ossai
- Sickle Cell and Young Stroke Survivors Charity, London, UK
| | - Maureen Gwam
- Sickle Cell and Young Stroke Survivors Charity, London, UK
| | - Fenella J Kirkham
- Department of Child Health, University Hospital Southampton, Southampton, UK. .,Developmental Neurosciences Section and NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. .,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Angela M Wade
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Christina Liossi
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Psychology, University of Southampton, Southampton, UK.,Department of Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Al Hudhaif J, Al Fayez AA, Alzahrani AS, Al Rajhi M. Brain infarction following elective laparoscopic cholecystectomy in a patient with sickle cell disease and previously undetected Moyamoya syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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de’Angelis N, Abdalla S, Carra MC, Lizzi V, Martínez-Pérez A, Habibi A, Bartolucci P, Galactéros F, Laurent A, Brunetti F. Low-impact laparoscopic cholecystectomy is associated with decreased postoperative morbidity in patients with sickle cell disease. Surg Endosc 2017; 32:2300-2311. [PMID: 29098436 DOI: 10.1007/s00464-017-5925-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/08/2017] [Indexed: 01/05/2023]
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7
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Leake PA, Reid M, Plummer J. A case series of cholecystectomy in Jamaican sickle cell disease patients - The need for a new strategy. Ann Med Surg (Lond) 2017; 15:37-42. [PMID: 28228943 PMCID: PMC5312456 DOI: 10.1016/j.amsu.2017.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 01/05/2023] Open
Abstract
High morbidity rates related to cholecystectomy in sickle cell disease (SCD) patients have been previously reported in the region. This study serves to assess the current outcomes related to cholecystectomy in a Jamaican SCD population. METHODS: A retrospective chart review of SCD patients undergoing elective cholecystectomy at the University Hospital of the West Indies over a 6-year period was performed providing relevant information for analysis. Patients were grouped on an intention-to-treat basis into an open and laparoscopic group. RESULTS: A total of 27 patients were included (18 laparoscopic and 9 open). Both groups were matched for age, gender and steady state hemoglobin. Only one patient (in the open group) received preoperative blood transfusion. The conversion rate for laparoscopy was 28%. Operative time was significantly longer in the open group (175.3 ± 62.1 vs. 125.9 ± 54.4 min, p = 0.0355). Bile duct exploration was undertaken in 66.7% of patients in the open group compared to 0% in the laparoscopic group. There was no significant difference between groups with respect to hospital stay, morbidity or mortality. The overall 30-day morbidity was 48.1% with acute chest syndrome being diagnosed in 6 patients and pneumonia in 7 patients. CONCLUSION: Morbidity rates related to cholecystectomy in the Jamaican SCD population remain high. Further studies to evaluate the factors contributing to such high morbidity in this population are warranted, with particular focus on laparoscopic cholecystectomy. Strategies such as preoperative transfusion and prophylactic cholecystectomy also need to be evaluated and considered in this patient group. Morbidity rates for cholecystectomy in Jamaican sickle cell patients remain high. There is a trend to higher morbidity for laparoscopic over open cholecystectomy. Preoperative transfusion is rarely employed in this patient population.
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Affiliation(s)
- Pierre-Anthony Leake
- Department of Surgery, Radiology, Anaesthetics & Intensive Care, University of the West Indies, Mona Campus, Jamaica
| | - Marvin Reid
- Tropical Metabolic Research Institute, University of the West Indies, Mona Campus, Jamaica
| | - Joseph Plummer
- Department of Surgery, Radiology, Anaesthetics & Intensive Care, University of the West Indies, Mona Campus, Jamaica
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8
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Davis BA, Allard S, Qureshi A, Porter JB, Pancham S, Win N, Cho G, Ryan K. Guidelines on red cell transfusion in sickle cell disease Part II: indications for transfusion. Br J Haematol 2016; 176:192-209. [DOI: 10.1111/bjh.14383] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Shubha Allard
- Barts Health NHS Trust & NHS Blood and Transplant; London UK
| | - Amrana Qureshi
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - John B. Porter
- University College London Hospitals NHS Foundation Trust; London UK
| | - Shivan Pancham
- Sandwell and West Birmingham Hospitals NHS Trust; Birmingham UK
| | - Nay Win
- NHS Blood and Transplant; London UK
| | | | - Kate Ryan
- Central Manchester University Hospitals NHS Foundation Trust; Manchester UK
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9
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Howard J, Inusa B, Liossi C, Jacob E, Murphy PB, Hart N, Gavlak J, Sahota S, Chorozoglou M, Nwosu C, Gwam M, Gupta A, Rees DC, Thein SL, Reading IC, Kirkham FJ, Cheng MYE. Prevention of Morbidity in sickle cell disease--qualitative outcomes, pain and quality of life in a randomised cross-over pilot trial of overnight supplementary oxygen and auto-adjusting continuous positive airways pressure (POMS2a): study protocol for a randomised controlled trial. Trials 2015; 16:376. [PMID: 26303626 PMCID: PMC4548303 DOI: 10.1186/s13063-015-0883-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/22/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Sickle cell anaemia (SCA) is an inherited disorder of haemoglobin. Patients experience long-term health care problems, affecting quality of life (QOL) including frequent acute pain, which is difficult to document in trials except as hospital admissions. Pilot data suggests that overnight respiratory support, either supplementary oxygen or auto-adjusting continuous positive airways pressure (APAP), is safe and may have clinical benefit. This pilot trial aims to determine which intervention is more acceptable to participants and whether there are other advantages of one over the other, e.g. in respiratory function or haematological parameters, before conducting the Phase 2 trial of overnight respiratory support funded by the National Institutes of Health Research. METHODS/DESIGN This is a pilot cross-over interventional trial with the order of interventions decided by simple randomization. Ten adults (age over 18 years) and 10 children (aged between 8 and 18 years) with homozygous sickle cell disease (haemoglobin SS, HbSS), recruited regardless of symptoms of sleep-disordered breathing, will undergo overnight pulse oximetry and will have two interventions, overnight oxygen and APAP, for a week each in randomised order with a washout week between interventions. Participants will complete online diaries via an iPad throughout the 29 days of the study and will complete QOL questionnaires and have measurement of haematology, biochemistry, spirometry and lung volumes (adults only) at 3 time points, at baseline and after each intervention, as well as in-depth semi-structured qualitative interviews after each intervention, carried out by an experienced psychologist. Both qualitative and statistical methods will be used to analyze the data. The primary outcome is qualitative data looking at participant experience from the transcribed interviews after each intervention. The participant's view on feasibility, acceptability and preference will specifically be explored. The QOL, laboratory and lung function data will be compared with baseline for each arm. DISCUSSION Patient and public involvement is an integral part of this trial and the key outcome is the qualitative result, which is dependent on obtaining good quality data to advise on participant feasibility, acceptability and preference. This is being addressed by using a standard interview. The development of a pain endpoint is another important outcome and collecting daily measurements is likely to be challenging. Research results will be used to inform design of the Phase 2 trial. TRIAL REGISTRATION ISRCTN46078697 18 July 2014.
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Affiliation(s)
- Jo Howard
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
| | - Baba Inusa
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
| | | | - Eufemia Jacob
- University of California Los Angeles, Los Angeles, CA, USA.
| | - Patrick B Murphy
- King's College London, London, UK.
- Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
| | - Nicholas Hart
- King's College London, London, UK.
- Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
| | - Johanna Gavlak
- Department of Child Health, University Hospital Southampton, Southampton, UK.
- Neurosciences Unit, University College London Institute of Child Health, London, UK.
| | - Sati Sahota
- Department of Child Health, University Hospital Southampton, Southampton, UK.
| | - Maria Chorozoglou
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
| | - Carol Nwosu
- Sickle Cell and Young Stroke Survivors Charity, London, UK.
| | - Maureen Gwam
- Sickle Cell and Young Stroke Survivors Charity, London, UK.
| | | | - David C Rees
- King's College London, London, UK.
- King's College hospital, London, UK.
| | - Swee Lay Thein
- King's College London, London, UK.
- King's College hospital, London, UK.
| | - Isabel C Reading
- University of Southampton, Southampton, UK.
- Research Design Service, University Hospital Southampton, Southampton, UK.
| | - Fenella J Kirkham
- University of Southampton, Southampton, UK.
- Department of Child Health, University Hospital Southampton, Southampton, UK.
- Neurosciences Unit, University College London Institute of Child Health, London, UK.
| | - Man Yeung Edith Cheng
- University of Southampton, Southampton, UK.
- Research Design Service, University Hospital Southampton, Southampton, UK.
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Cawich SO, Arthurs M, Murphy T, Bonadie KO, Roberts HA, Naraynsingh V. Complications of ERCP for choledocholithiasis in a sickle cell cohort. Trop Doct 2014; 45:15-20. [PMID: 25315239 DOI: 10.1177/0049475514552550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Patients with sickle cell disease (SCD) demand special attention during clinical interventions because they are predisposed to acute chest syndrome (ACS), vaso-occlusive crises, intra-vascular haemolysis and immune paresis. Although SCD is endemic in the Caribbean, there has been no report on endoscopic retrograde cholangio-pancreatography (ERCP) outcomes in these patients from this region. Study The records of patients with SCD who underwent ERCP between 1 January 2005 and 1 June 2010 were analysed retrospectively. Parameters assessed included patient demographics, procedural details, ERCP-related and SCD-related morbidity. Data were analysed using SPSS version 12.0. Results Fifty-four patients with SCD were subjected to ERCP during the study period. There were 37 women and 17 men at a mean age of 28 years (SD +/−12.05). There was 29% (16) overall morbidity, with 10 (18.5%) SCD-related complications and six (11.1%) ERCP-specific complications. More common complications were: pancreatitis (9.3%); cholangitis (1.9%); ACS (9.3%); pneumonia (3.7%); and painful crises (5.6%). There was one death (1.9%) due to multiple organ failure secondary to severe pancreatitis. Conclusions This study suggests that the SCD cohort requires special perioperative attention to minimise the inordinately high morbidity, many of which are SCD-related. We propose a perioperative management protocol that may minimise morbidity in these patients.
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Affiliation(s)
- Shamir O Cawich
- Hepatopancreatobiliary Surgeon, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago
| | - Milton Arthurs
- Gastroenterologist, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica
| | - Trevor Murphy
- Gastroenterologist, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica
| | - Kimon O Bonadie
- Hepatopancreatobiliary Surgeon, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago
| | - Hugh A Roberts
- General Surgeon, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica
| | - Vijay Naraynsingh
- Professor of Surgery, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago
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11
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Laparoscopic cholecystectomy in adult patients with sickle cell disease. Surg Laparosc Endosc Percutan Tech 2013; 22:454-8. [PMID: 23047392 DOI: 10.1097/sle.0b013e3182619408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
SUMMARY BACKGROUND DATA A gallstone is a common disease in sickle cell disease (SCD) patients, and cholecystectomy is the most common surgical procedure performed in patients with SCD. We conducted this study to determine the outcome of laparoscopic cholecystectomy (LC) as the standard surgical treatment for gallstones in adult patients with sickle cell anemia over a long period. PATIENTS AND METHODS Data of all the SCD patients who were operated between April 1994 and December 2008 were collected retrospectively. We analyzed data including age, sex, mode of admission (elective or emergency), indication for LC (chronic or acute cholecystitis), operation time, length of hospital stay, and complications. RESULTS : During 1994 to 2008, there were 6014 patients who underwent LC; of those, 496 (8.25%) patients were SCD patients. The results showed significant differences in the outcome, operative time, hospital stay, and complication rate between 1994 and 2008. CONCLUSIONS LC is a safe procedure in sickle cell patients with a low morbidity rate.
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12
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Aziz AM, Meshikhes AWN. Blood transfusion in patients with sickle cell disease requiring laparoscopic cholecystectomy. JSLS 2012; 15:480-5. [PMID: 22643502 PMCID: PMC3340956 DOI: 10.4293/108680811x13176785203996] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Laparoscopic cholecystectomy in patients with sickle cell disease was found to be safe without preoperative blood transfusion. Background: Surgery in patients with sickle cell disease is associated with high morbidity. To reduce this high morbidity, different preoperative transfusion regimens were introduced. However, blood transfusion is associated with problems. This prospective study aims to establish the safety of conducting laparoscopic cholecystectomy without transfusion in sickle cell disease patients. Methods: Forty patients (16 males and 24 females; mean age 26.6 years) undergoing laparoscopic cholecystectomy for cholelithiasis were divided into 2 matched groups: Group I “no transfusion” (n=24 patients; 60%) and Group II “transfusion” (n=16; 40%). In Group II, 9 patients (22.5%) received a simple transfusion and 7 (17.5%) a partial exchange transfusion. Results: Group II patients had significantly higher levels of Hb-S prior to transfusion. They developed a significantly higher complication rate (25% vs. 0%) and subsequently longer hospital stay (3.9±2 vs. 2.1±1.4). Moreover, there was no significant difference in the complications between the simple transfusion and partial exchange transfusion subgroups. Conclusion: Surgery in SCD patients is safe without a preoperative blood transfusion. Moreover, preoperative blood transfusion is associated with significantly higher postoperative complications and longer hospital stay. Hence, a “no transfusion” policy is recommended.
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Affiliation(s)
- Amr Mostafa Aziz
- Department of Surgery, King Fahad Specialist Hospital, Eastern Province, Saudi Arabia
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13
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Reshetnyak VI. Concept of the pathogenesis and treatment of cholelithiasis. World J Hepatol 2012; 4:18-34. [PMID: 22400083 PMCID: PMC3295849 DOI: 10.4254/wjh.v4.i2.18] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/15/2011] [Accepted: 02/24/2012] [Indexed: 02/06/2023] Open
Abstract
Gallstone disease (GD) is a chronic recurrent hepatobiliary disease, the basis for which is the impaired metabolism of cholesterol, bilirubin and bile acids, which is characterized by the formation of gallstones in the hepatic bile duct, common bile duct, or gallbladder. GD is one of the most prevalent gastrointestinal diseases with a substantial burden to health care systems. GD can result in serious outcomes, such as acute gallstone pancreatitis and gallbladder cancer. The epidemiology, pathogenesis and treatment of GD are discussed in this review. The prevalence of GD varies widely by region. The prevalence of gallstone disease has increased in recent years. This is connected with a change in lifestyle: reduction of motor activity, reduction of the physical load and changes to diets. One of the important benefits of early screening for gallstone disease is that ultrasonography can detect asymptomatic cases, which results in early treatment and the prevention of serious outcomes. The pathogenesis of GD is suggested to be multifactorial and probably develops from complex interactions between many genetic and environmental factors. It suggests that corticosteroids and oral contraceptives, which contain hormones related to steroid hormones, may be regarded as a model system of cholelithiasis development in man. The achievement in the study of the physiology of bile formation and the pathogenesis of GD has allowed expanding indications for therapeutic treatment of GD.
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Affiliation(s)
- Vasiliy Ivanovich Reshetnyak
- Vasiliy Ivanovich Reshetnyak, VA Negovsky Scientific Research Institute of General Reanimatology, Russia Academy of Medical Sciences, Moscow 107031, Russia
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Fisher L. Perioperative care of the patient with sickle cell disease. AORN J 2011; 93:150-6; quiz 157-9. [PMID: 21193088 DOI: 10.1016/j.aorn.2010.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 08/24/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Lisa Fisher
- Children's Healthcare of Atlanta, Aflac Cancer Center & Blood Disorders Services (Outpatient Clinic), Atlanta, GA, USA
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Marulanda GA, Minniti CP, Ulrich SD, Seyler TM, Mont MA. Perioperative management for orthopaedic patients with sickle cell anaemia. J Orthop Surg (Hong Kong) 2009; 17:346-50. [PMID: 20065378 DOI: 10.1177/230949900901700321] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries. METHODS 12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician. In the aggressive management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to 9 to 11 g/dl and to lower the haemoglobin S level to <30%. Fresh frozen plasma was given when their Factor VII level was <30%. In the conservative management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to a minimum of 10 g/dl. Fresh frozen plasma or packed red blood cells were given intra-operatively only when excessive bleeding occurred. The length of hospital stay, the number of perioperative complications, the number of transfusions, and episodes of alloimmunisation and/or vaso-occlusive crises in the two groups were compared. RESULTS No patient in the aggressive management group received supplemental oxygen or had an estimated intra-operative blood loss of >400 ml. Three patients in the conservative management group received multiple intra- and post-operative transfusions and supplemental oxygen. CONCLUSION Both aggressive and conservative protocols may be safely used in SCA patients. The more aggressive protocol resulted in lower rates for postoperative complications, transfusions, and resorting to supplemental oxygen.
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Affiliation(s)
- German A Marulanda
- Department of Orthopaedics and Sport Medicine, University of South Florida, Tampa, Florida, USA
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Dinan MA, Chou CH, Hammill BG, Graham FL, Schulman KA, Telen MJ, Reed SD. Outcomes of inpatients with and without sickle cell disease after high-volume surgical procedures. Am J Hematol 2009; 84:703-9. [PMID: 19787790 DOI: 10.1002/ajh.21520] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study, we examined differences in inpatient costs, length of stay, and in-hospital mortality between hospitalizations for patients with and without sickle cell disease (SCD) undergoing high-volume surgical procedures. We used Clinical Classification Software (CCS) codes to identify discharges in the 2002-2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for patients who had undergone either cholecystectomy or hip replacement. We limited the non-SCD cohort to hospitals where patients with SCD had undergone the same procedure. We compared inpatient outcomes using summary statistics and generalized linear regression analysis to adjust for patient, hospital, and procedural characteristics. Overall, the median age of surgical patients with SCD was more than three decades less than the median age of patients without SCD undergoing the same procedure. In recognition of the age disparity, we limited the analyses to patients aged 18 to 64 years. Nonetheless, patients with SCD undergoing cholecystectomy or hip replacement were 12.1 and 14.4 years younger, had inpatient stays that were 73% and 82% longer, and incurred costs that were 46% and 40% higher per discharge than patients without SCD, respectively. Inpatient mortality for these procedures was low, approximately 0.6% for cholecystectomy and 0.2% for hip replacement and did not differ significantly between patients with and without SCD. Multivariable regression analyses revealed that higher inpatient costs among patients with SCD were primarily attributable to longer hospital stays. Patients with SCD who underwent cholecystectomy or hip replacement required more health care resources than patients without SCD. Am. J. Hematol. 2009. (c) 2009 Wiley-Liss, Inc.
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Affiliation(s)
- Michaela A Dinan
- Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
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Al-Mulhim AS, Al-Mulhim AA. Laparoscopic cholecystectomy in 427 adults with sickle cell disease: a single-center experience. Surg Endosc 2009; 23:1599-602. [DOI: 10.1007/s00464-009-0501-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 03/03/2009] [Accepted: 03/29/2009] [Indexed: 01/10/2023]
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Dan D, Seetahal S, Harnanan D, Singh Y, Hariharan S, Naraynsingh V. Laparoscopic cholecystectomy in sickle cell disease patients: does operating time matter? Int J Surg 2008; 7:70-3. [PMID: 19038591 DOI: 10.1016/j.ijsu.2008.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Accepted: 10/27/2008] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To report the experience of performing laparoscopic cholecystectomy (LC) in patients suffering from sickle cell disease (SCD), and to assess if their postoperative complications can be minimized by shortening the operating time. METHODS Strict measures were taken to minimize the operating times and duration of pneumoperitoneum in SCD patients undergoing LC. Data collected included demographics, preoperative haemoglobin, the surgical technique used, operating times, insufflation pressures, perioperative complications and hospital length of stay. RESULTS In the 5-year period from July 2003 to June 2008, 19 patients with SCD underwent elective LC. Of these, 84% were female. The mean age was 21.5 years. The most common indication for surgery was symptomatic cholelithiasis (60%). The mean preoperative haemoglobin was 8.2g/dL. No preoperative blood transfusions were given. Four patients had preoperative endoscopic retrograde cholangiopancreatography (ERCP). Mean operating time was 27.9 min (range 20-45 min) which is 2.5-6 times quicker than most reports in the literature. There was no conversion to open surgery. Mean hospital length of stay was 2.5 days. Postoperative complications were noted in four patients with painful crises accounting for 50%. There was no mortality. CONCLUSION The study suggests that if stringent measures are taken to shorten the operating time, LC can be safely and effectively performed in SCD patients with minimal perioperative complications.
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Affiliation(s)
- Dilip Dan
- Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Mount Hope, West Indies, Trinidad and Tobago
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Afenyi-Annan A, Willis MS, Konrad TR, Lottenberg R. Blood bank management of sickle cell patients at comprehensive sickle cell centers. Transfusion 2007; 47:2089-97. [PMID: 17958539 DOI: 10.1111/j.1537-2995.2007.01434.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
BACKGROUND Transfusion therapy has been integral to decreasing morbidity and mortality in sickle cell disease (SCD). Several studies however, have demonstrated variation in the blood bank (BB) practices for these patients. The purpose of this study was to examine BB practices for SCD patients at NIH Comprehensive Sickle Cell Centers (CSCCs) and to determine whether consensus in BB management exists. STUDY DESIGN AND METHODS A cross-sectional survey of BB medical directors and laboratory supervisors at CSCCs was conducted between October 2004 and March 2005. The survey assessed respondent, hospital, and BB characteristics; pretransfusion procedures; blood product selection; and agreement with statements about consensus in management. Physician respondents were also asked to select their preferred management strategy in four hypothetical transfusion-related cases. RESULTS Responses were received from 36 of 49 (73.5%) institutions. Pretransfusion procedures and blood product selection were nearly uniform among CSCCs. Of the respondents, 69 percent disagreed with the statement that clear consensus exists on the use of phenotypically matched red blood cells for SCD patients; 55 percent disagreed that clear consensus exists on the use of chronic transfusion programs for SCD patients. Although there was consensus on the use of transfusion therapy for life- or organ-threatening situations, optimal management of preoperative transfusion therapy and severe delayed transfusion reactions appears controversial. CONCLUSION This study provides the first overview of BB management of patients with SCD at CSCCs and identifies areas where there is perceived and actual lack of consensus. These results suggest that opportunities remain to standardize transfusion practices for SCD patients across all hospital settings.
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Affiliation(s)
- Araba Afenyi-Annan
- Department of Pathology & Laboratory Medicine and the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina 27514-7600, USA.
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