Inpatient Clinical Pathway for Sickle Cell and Acute Chest Syndrome
Related Pathways
Diagnostic Criteria for ACS
- New infiltrate on CXR involving at least 1 lung segment that is not c/w atelectasis
- AND 1 or more of the following:
- Chest pain
- T ≥ 38.5°C
- Respiratory symptoms: cough, tachypnea, WOB, wheeze
- Hypoxemia relative to baseline measurements
Does not meet criteria for ACS
Reassuring PE, labs
Reassuring PE, labs
Does not meet criteria for ACS
But concerning Hx, symptoms
But concerning Hx, symptoms
Meets criteria for ACS
New infiltrate + symptoms
New infiltrate + symptoms
- Further diagnostic work-up as clinically indicated
- Treat pain, fever
- Sickle Cell with Fever
- Sickle Cell with Pain
Close monitoring of symptoms and escalation
of therapy can prevent ACS progression
of therapy can prevent ACS progression
- Acute Chest Treatment
- Additional laboratory studies
- Monitoring
- Respiratory support
- Oxygen, spirometry, airway clearance
- Albuterol
- Fluid management
- Antibiotic recommendations
- Analgesia
- Steroids
- Transfusion therapy
- Consultation, ICU considerations
- Sickle cell disease
- Spirometry use
- Recommended Follow-Up
Posted: December 2020
Revised: November 2022
Authors: A. Bhandari, MD; K. Smith-Whitley, MD; C. Norris, MD; L. Ward, RT; T. McKnight, CRNP; J. Allen, MD; K. Miller, MD; B. Weeks, MSN; K. Tsukahara, MD
Revised: November 2022
Authors: A. Bhandari, MD; K. Smith-Whitley, MD; C. Norris, MD; L. Ward, RT; T. McKnight, CRNP; J. Allen, MD; K. Miller, MD; B. Weeks, MSN; K. Tsukahara, MD
Evidence
- Management of Sickle Cell Disease: Summary of the 2014 Evidence-Based Report by Expert Panel Members
- Pulmonary Complications of Sickle Cell Disease
- Lung Function in Sickle Cell Disease
- The Use of Incentive Spirometry in Pediatric Patients with Sickle Cell Disease to Reduce the Incidence of Acute Chest Syndrome
- Causes and Outcomes of the Acute Chest Syndrome in Sickle Cell Disease
- Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014.
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