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

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 (rCO(2)) and splanchnic regional (rSO(2)) 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), rSO(2) (D = 11.6), and rCO(2) (D = 9.3), all increased over time. CO max and CI max were achieved 1 h after starting resuscitation. rCO(2) max attainment was quicker than rSO(2), as monitored by NIRS. CI max correlated with rCO(2) max (r = −0.350) and rSO(2) max (r = −0.359). In adjustment models, initial CI significantly impacted initial rCO(2) (p = 0.045) and rCO(2) max (p = 0.043), while initial CO impacted rCO(2) 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.