Inpatient Clinical Pathway for Sickle Cell and Acute Chest Syndrome

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
Does not meet criteria for ACS
But concerning Hx, symptoms
Meets criteria for ACS
New infiltrate + symptoms
Close monitoring of symptoms and escalation
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
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