Acute chest syndrome

(Redirected from Acute Chest Syndrome)

Background

  • A leading cause of hospitalization and death in adults with sickle cell disease
  • Occurs most commonly in the 2-4yr old age group and then declines with age
  • Due to pulmonary ischemia and infarction; complication of pneumonia

Causes

Clinical Features

Complications

Differential Diagnosis

Sickle cell crisis

Evaluation

Work-Up

  • CBC
  • Retic count
  • VBG / ABG
  • Blood culture /sputum cultures
  • CXR

Evaluation

Management

  • O2
    • Titrate to pulse oximetry >92%
  • Incentive Spirometer
  • Hydration
  • Analgesia
    • Pulmonary toilet is important but avoid excessive sedation
  • Bronchodilators
  • Antibiotics
  • Transfusion (leucocyte depleted)
    • Consider transfusion to goal of hemoglobin 11 / hematocrit 30 for:
      • O2 Sat <92% on room air
      • hematocrit 10-20% below patient's usual hematocrit or dropping hematocrit
  • Exchange transfusion
    • Consider for:
      • Progression of acute chest syndrome despite simple transfusion
      • Severe hypoxemia
      • Multi-lobar disease
      • Previous history of severe acute chest syndrome or cardiopulmonary disease

See Also

Video

References

  1. Novelli EM, Gladwin MT. Crises in Sickle Cell Disease. Chest. 2016; 149 (4): 1082-1093.
  2. Razazi et al. Bedside Lung Ultrasound During Acute Chest Syndrome in Sickle Cell Disease. Medicine (Baltimore). 2016 Feb; 95(7): e2553.

Authors:

Ross Donaldson