Advanced Practice: Management of Acute Chest Syndrome with Dr. Lou Argentine


5 steps to Managing Acute Chest Syndrome in adult population



  1. FLUIDS: 

    • Oral hydration preferred

    • IVF w/ hypotonic fluid if clinically dehydrated or if poor PO intake/vomiting

    • aggressive IV hydration can worsen symptoms/outcome

2.   OXYGEN:

    • only if hypoxia present, titrate to pulse ox > 92%, adjust O2 according to pulse ox

    • inhaled b2 agonist if wheezing occurs

3.   PAIN:

    • usually require high dose parental opioids

    • pain management promotes pulmonary toilet

    • avoid over sedation, monitor for respiratory distress


    • two most common organisms: chlamydia pneumonia and mycoplasma pneumonia

    • cover both typical and atypical pathogens:  3rd generation cephalosporin and macrolide


    • exchange transfusion preferred

    • goal to increase hemoglobin A levels above 70%

    • consider when:

          • Hx of requiring ventilator support or worsening hypoxemia despite management above - can help prevent intubation

          • patient already required intubation - useful to shorten duration of intubation

          • suspected/confirmed fat or bone marrow embolism



            REMEMBER: Acute chest syndrome is leading cause of death in patients with SCD in US!