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.
