Critical Appraisal of Research Evidence

Critical Appraisal of Research Evidence

Adams-Graves, P., Ostric, E., Martin, M., Richardson, P., & Lewis, J. r. (2008). Sickle cell hospital unit: a disease-specific model.

According to the authors, pain is the most characteristic and debilitating complication of sickle cell anemia, although the great variability of this syndrome, some have a life with few pictures of pain or minimal manifestations. At the other extreme are patients suffering práctiamente pain episodes daily. The mechanisms responsible for this complication are poorly understood.

These episodes may occur in patients as young as 6 months old and at unpredictable intervals throughout life. Sometimes they are managed at home without contact with the doctor. If treated improperly, the pain of vaso-occlusive crises can cause serious consequences, including trigger acute chest syndrome. The operation usually involves rest, hydration and analgesia. Requires frequent systematic pain assessment and continuous adjustments of relief measures, especially analgesics. Intravenous hydration should be done generously and hypotonic solutions to prevent hyperviscosity and sickling.

Haywood, C., Beach, M., Lanzkron, S., Strouse, J., & Wilson, R. (2009). A systematic review of barriers and interventions to improve appropriate use of therapies for sickle cell disease. According to the authors, a variety of analgesics can be used, since intravenous acetaminophen or NSAIDs, and opioids orally or parenterally. Each has its advantages and disadvantages. Hospital management is based on opioid analgesia controlled by the patient, rather than on-demand treatment. Morphine can be initiated with 0.05 mg / kg every 4 hours on demand, or by continuous infusion at 0.02 mg / kg / h, and then increased or adjusted according to response, not to mention side effects like nausea, constipation, pruritus and hypoventilation. It should always have available the antagonist naloxone. Nubain is an alternative to morphine.

The dose of the opioid to achieve relief varies between episodes and between patients. Evaluate the amount of analgesics applied in relation to the improvement in pain and assist the child to adjust patient-controlled doses and achieve optimal control or change the regime in case he is unable to take control in handling. The evolution varies according to the type of analgesics, route, frequency and opioid requirements.

Jamison, C., & Brown, H. (2002). A special treatment program for patients with sickle cell crisis.

According to the author, functional asplenia begins during the first year of age, leading to an increased susceptibility to severe infections by encapsulated bacteria, such as pneumococcus, Haemophilus influenza and meningococcus. And bacteremia infections are a major cause of morbidity and mortality in children sickle, with the justification for universal neonatal screening. Penicillin prophylaxis should be initiated at two months of age and treated aggressively each febrile episode with parenteral antibiotics and close monitoring (8,17,19). The vaccination schedule is paramount, with emphasis on vaccine: Haemophilus type B, 13V Pneumococcal, Meningococcal and 23-valent.

Hospitalize all patients younger than 1 year, or any age with risk criteria: signs of systemic toxicity, or evidence of other complications (severe, aplastic crisis, splenic sequestration, acute chest syndrome, hemiplegia, priapism) or sepsis prior ...