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 consistent with atelectasis and
- 1 or more of the following:
- Chest pain
- T ≥ 38.5°C
- Respiratory symptoms: cough, tachypnea, WOB, wheeze
- Hypoxemia relative to baseline
Does not meet criteria for ACS
Reassuring PE, labs
Reassuring PE, labs
Does not meet criteria for ACS
Concerning history, symptoms
Concerning history, 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
- Oxygen, spirometry,
- Fluid management
- Antibiotic recommendations
- Analgesia
- Steroids
- Transfusion therapy
- Consultation, ICU considerations
- Sickle cell disease
- Spirometry use
- Recommended Follow-up
Evidence
- Benefit of Pulmonary Subspecialty Care for Children with Sickle Cell Disease and Asthma
- 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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