Acute chest syndrome

Background

1. Occurs most commonly in the 2-4yr old age group and then declines with age
2. Causes
   1. Pulmonary infection
      1. C. pneumoniae and mycoplasma are most common organisms
      2. May also be caused by viruses, H. flu, klebsiella, staph
   2. Fat emboli
      1. Lodge in pulmonary vasculature -> additional ischemia
   3. Rib infarction
   4. Overly aggressive IV hydration

Work-Up

1. CBC
2. Retic count
3. VBG
4. Bcx /sputum cx

Diagnosis

1. New infiltrate on CXR with at least one of the following:
   1. Fever >38.5
   2. Cough
   3. Wheezing
   4. Tachypnea
   5. Chest pain
2. Note: CXR findings may lag behind the clinical features

Treatment

1. O2
   1. Titrate to pulse oximetry
2. Hydration
   1. Oral hydration preferred
   2. IV hydration with hypotonic fluid if pt unable to tolerate PO
3. Analgesia
4. Bronchodilators
5. Abx
   1. Treat as if pt has community-acquired PNA
6. Tranfusion (leukocycte depleted)
   1. Consider transfusion to goal of Hb 11 / Hct 30 for:
   2. O2 Sat <92% on room air
   3. Hct 10-20% below pt's usual Hct or dropping Hct
7. Exchange transfusion
   1. Consider for:
      1. Progression of ACS despite simple transfusion
      2. Severe hypoxemia
      3. Multi-lobar disease
      4. Previous history of severe ACS or cardiopulmonary disease

Complications

1. Pulmonary Embolism (bone marrow, fat or thrombotic)
2. Pneumonia
3. CVA
4. Sepsis

See Also

Sickle Cell Crisis

Source

• Tintinalli
• UpToDate