Date of Graduation
Master of Science in Physician Assistant Studies
Torry Cobb, DHSc, MPH, PA-C
Annjanette Sommers MS, PAC
Background: Acute vaso-occlusive crisis is a common occurrence in patients with Sickle Cell disease. The main symptom is pain, which is currently treated with medication such as morphine. Further treatments to alleviate pain would be beneficial to patients suffering from this condition. One possible treatment is inhaled nitric oxide. To review evidence of the efficacy of nitric oxide, the GRADE tool will be used to evaluate the strength of existing study data.
Method: PubMed, NLM Gateway, Medline, and EBM Multifile were used to perform an exhaustive search of medical literature. Results were limited to studies with human subjects that were published in English in 2000 or later.
Results: Three studies were reviewed, all of which were randomized controlled trials. All had small study sizes, and studied the subjective outcome of patient-evaluated pain level. Two of the three showed positive results for reduction in pain with inhaled nitric oxide therapy, and one study showed no change in pain with inhaled nitric oxide therapy. The primary outcome of decreased pain was graded as a moderate. Other outcomes of length of hospital stay and amount of pain medication used were also graded as moderate, however the outcomes of methemoglobin levels and harm were graded as high quality outcomes.
Conclusion: It is difficult to clearly state that inhaled nitric oxide does or does not decrease pain in acute vaso-occlusive crisis in patients with Sickle Cell disease. No adverse side effects have been seen, and some patients have reported decreased pain with nitric oxide; even if not shown to be statistically significant, this could be significant to the patient in question. Therefore, the option should currently be based not only on physician preference, but also on patient preference. Larger studies need to be conducted to increase current knowledge.
Huffaker, Kristina, "The Effect of Nitric Oxide on Pain From Acute Vascular Occlusion Crisis in Sickle Cell Disease: A Systematic Review" (2011). School of Physician Assistant Studies. 263.