The Use of Warmed Saline in Vaso-occlusive Episodes
The Use of Warmed Saline in Vaso-occlusive Episodes
The purpose of this study is to determine if warming the intravenous (IV) fluid given to
 patients with Sickle Cell Disease who are experiencing painful episodes known as
 Vaso-Occlusive Episodes; will decrease rates of hospital admission, decrease amounts of IV
 pain medications given, improve pain and improve global comfort.
Vaso-occlusive crisis (VOC) is a common painful complication of Sickle Cell Disease and is
 the primary reason that these patients seek medical care in the acute care setting. This
 complication arises when blood vessels are obstructed by sickled red blood cells resulting in
 ischemic injury.

 The standard management of these painful episodes comprises the administration of opioid
 analgesics, the infusion of intravenous (IV) fluids at room temperature and rest. These
 episodes often last five to seven days and many patients require inpatient management for
 continued administration of intravenous analgesics.

 The public health impact of the disease is large as admissions frequently result in school or
 work absences and can be financially and emotionally taxing.

 It is well established that exposure to cold precipitates VOC. For this reason, management of
 the pain of VOC in some centers includes the use of warming blankets as an adjunct for pain
 relief. It is conceptually appealing to conjecture that warm fluids might have similar
 salutary effects on VOC. This conjecture is bolstered by the physiologic effect of
 temperature on vascular tone. Specifically, it is well established that cold temperatures
 cause vasoconstriction whereas warm temperatures cause vasodilation. We expect that warmed
 fluids will similarly induce vasodilation, improving blood flow to vaso-occluded ischemic
 areas.
Inclusion Criteria:

 -  Vaso-occlusive Episode defined as a pain rating of 3 or above on the Wong-Baker FACES
 score in a child with an established diagnosis of sickle cell disease (SS, SC or S β
 Thalassemia)

 -  4-21 years of age

 Exclusion Criteria:

 -  fever (temperature greater than 38 degrees Celsius)

 -  inability to complete FACES pain scale

 -  evidence of acute chest syndrome clinically or radiographically

 -  deemed by attending physician to be so ill as to need immediate hospital admission.