Acute chest syndrome: Difference between revisions
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*Occurs most commonly in the 2-4yr old age group and then declines with age | *Occurs most commonly in the 2-4yr old age group and then declines with age | ||
*Due to pulmonary ischemia and infarction; complication of PNA | *Due to pulmonary ischemia and infarction; complication of PNA | ||
===Causes=== | |||
** | *Pulmonary infection | ||
**[[C. pneumoniae]] and [[mycoplasma]] are most common organisms | |||
* | **May also be caused by viruses, [[H. flu]], [[klebsiella]], [[staph]] | ||
*[[Fat emboli]] | |||
**Lodge in pulmonary vasculature -> additional ischemia | |||
*Rib infarction | |||
*Overly aggressive IV hydration | |||
==Clinical Features== | ==Clinical Features== | ||
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#[[Bronchodilators]] | #[[Bronchodilators]] | ||
#[[Antibiotics]] | #[[Antibiotics]] | ||
#* | #*3rd generation [[cephalosporin]] + [[macrolide]] | ||
#[[Transfusion]] (leukocycte depleted) | #[[Transfusion]] (leukocycte depleted) | ||
#*Consider transfusion to goal of Hb 11 / Hct 30 for: | #*Consider transfusion to goal of Hb 11 / Hct 30 for: | ||
Revision as of 15:30, 23 September 2015
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 PNA
Causes
- Pulmonary infection
- C. pneumoniae and mycoplasma are most common organisms
- May also be caused by viruses, H. flu, klebsiella, staph
- Fat emboli
- Lodge in pulmonary vasculature -> additional ischemia
- Rib infarction
- Overly aggressive IV hydration
Clinical Features
- Fever >38.5
- Cough
- Wheezing
- Tachypnea
- Chest pain
Differential Diagnosis
Sickle cell crisis
- Vaso-occlusive pain crisis
- Bony infarction
- Dactylitis
- Avascular necrosis of femoral head
- Acute chest syndrome
- Asthma
- Pulmonary hypertension
- Gallbladder disease
- Acute hepatic sequestration
- Infection
- Parvovirus B19
- Splenic sequestration
- CVA
- Cerebral aneurysm and ICH
- Priapism
- Papillary necrosis
Diagnosis
Work-Up
- CBC
- Retic count
- VBG / ABG
- Bcx /sputum cx
- CXR
Evaluation
- New infiltrate on CXR with at least one of the following:
- Fever >38.5
- Cough
- Wheezing
- Tachypnea
- Chest pain
- Note: CXR findings may lag behind the clinical features
Treatment
- O2
- Titrate to pulse oximetry
- Incentive Spirometer
- Hydration
- Oral hydration preferred
- IV hydration with hypotonic fluid if pt unable to tolerate PO
- Analgesia
- Pulmonary toilet is important but avoid excessive sedation
- Bronchodilators
- Antibiotics
- 3rd generation cephalosporin + macrolide
- Transfusion (leukocycte depleted)
- Consider transfusion to goal of Hb 11 / Hct 30 for:
- O2 Sat <92% on room air
- Hct 10-20% below pt's usual Hct or dropping Hct
- Consider transfusion to goal of Hb 11 / Hct 30 for:
- 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
- Consider for:
Complications
- Pulmonary Embolism (bone marrow, fat or thrombotic)
- Pneumonia
- CVA
- Sepsis