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

4.   ANTIBIOTICS:

• two most common organisms: chlamydia pneumonia and mycoplasma pneumonia

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

5.   TRANSFUSION:

• 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!