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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.