Treatments and outcomes of the acute chest syndromes

Available dataAll patients (n=39)
 Supplemental oxygen at admission, L·min−1394 (2–5)
  1–5 L·min−129 (74)
  >5 L·min−110 (26)
 Mechanical ventilation391 (3)
 Antimicrobial therapy3939 (100)
 Blood product transfusion3914 (36)
 ICU length of stay, days394 (3–5)
 Hospital length of stay, days3910 (7–13)
 Supplemental oxygen at 48 h from admission36
  0 L·min−13 (8)
  1–5 L·min−132 (89)
  >5 L·min−11 (3)
 Death#391 (3)

Data are presented as n, median (interquartile range) or n (%). ICU: intensive care unit. #: the patient who died was a 34-year-old male nonsmoker of normal weight (body mass index 18.4 kg·m−2), with a history of multiple vaso-occlusive crises and acute chest syndrome (ACS), bone complications and cholecystectomy. He presented at hospital for isolated fever initially, but rapidly developed a meningeal syndrome, signs of ACS (fever, chest pain and dyspnoea with opacities on chest radiography) with 6 L·min−1 need of oxygen, and was referred to the ICU. Large basal consolidations were evidenced on computed tomography scan, without pulmonary embolism. Streptococcus pneumoniae was identified in the cerebrospinal fluid, but respiratory tract samples remained sterile. Laboratory findings included a severe central bicytopenia (haemoglobin 4.4 g·dL−1, reticulocytes 20 300 cells·mm−3, platelets 91 000 cells·mm−3) and high inflammation (leukocytes 35 600 cells·mm−3). The patient had an intermediate probability of pulmonary hypertension at initial transthoracic echocardiography. Initial levels of erythrocyte- and platelet-derived microparticles were low (1398 and 1601 microparticles per μL plasma, respectively). Despite antibiotics and transfusion, the patient deteriorated and developed confusion, acute respiratory failure and acute renal failure requiring intubation and dialysis. The signs evolved towards a severe and fatal acute respiratory distress syndrome 6 days after ICU admission.