Acute chest syndrome: Difference between revisions
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==Management==
==Management==
#[[O2]]
*[[O2]]
#*Titrate to pulse oximetry >92%
**Titrate to pulse oximetry >92%
#Incentive Spirometer
*Incentive Spirometer
#Hydration
*Hydration
#*[[oral rehydration therapy|Oral hydration]] preferred
**[[oral rehydration therapy|Oral hydration]] preferred
#*[[IV hydration]] with hypotonic fluid if patient unable to tolerate PO
**[[IV hydration]] with hypotonic fluid if patient unable to tolerate PO
#[[Analgesia]]
*[[Analgesia]]
#*Pulmonary toilet is important but avoid excessive sedation
**Pulmonary toilet is important but avoid excessive sedation
#[[Bronchodilators]]
*[[Bronchodilators]]
#[[Antibiotics]]
*[[Antibiotics]]
#*3rd generation [[cephalosporin]] + [[macrolide]]
**3rd generation [[cephalosporin]] + [[macrolide]]
#[[Transfusion]] (leucocyte depleted)
*[[Transfusion]] (leucocyte depleted)
#*Consider [[pRBCs|transfusion]] to goal of hemoglobin 11 / hematocrit 30 for:
**Consider [[pRBCs|transfusion]] to goal of hemoglobin 11 / hematocrit 30 for:
#**O2 Sat <92% on room air
***O2 Sat <92% on room air
#**hematocrit 10-20% below patient's usual hematocrit or dropping hematocrit
***hematocrit 10-20% below patient's usual hematocrit or dropping hematocrit
#[[Exchange transfusion]]
*[[Exchange transfusion]]
#*Consider for:
**Consider for:
#**Progression of acute chest syndrome despite simple transfusion
***Progression of acute chest syndrome despite simple transfusion
#**Severe hypoxemia
***Severe hypoxemia
#**Multi-lobar disease
***Multi-lobar disease
#**Previous history of severe acute chest syndrome or cardiopulmonary disease
***Previous history of severe acute chest syndrome or cardiopulmonary disease


==See Also==
==See Also==

Revision as of 18:17, 1 October 2019

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

{{#widget:YouTube|id=pKxAsqj4GOE}}

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.
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