Acute Chest Syndrome

• Acute chest syndrome (ACS) accounts for the most common cause of ICU admission and the most common cause of death in sickle cell patients.
• Important pearls for ACS include:
  • Chlamydophila pneumonia is the most common bacterial cause of ACS in adults, whereas Mycoplasma pneumonia is the most common bacterial cause in children.
  • CXR abnormalities may be absent early in disease.
  • Children are more likely to have middle lobe disease, in contrast to adults who often have lower lobe involvement.
  • Acute RV failure is a well recognized complication of ACS - use ultrasound to evaluate the RV and be careful with fluids.

References

Cecchini J, Fartoukh M. Sickle cell disease in the ICU. Curr Opin Crit Care 2015; 21:569-75.