Acute Chest Syndrome (ACS) in pediatric patients admitted to a Pediatric Critical Care Unit (PCCU)

Purpose: To describe patients with sickle cell anemia and ACS (fever, pulmonary pathology and abnormal chest radiograph) who required admission to the PCCU and to compare the effects of simple transfusion (ST) versus exchange transfusion (ET) on their clinical course. Methods: All patients admitted to the PCCU for ACS between 1989-1994 were divided into either Group 1 (ST) or Group 2 (ET). Parameters examined included: clinical presentation, length of illness, fever, hemoglobin (Hb) level, PRISM score, A-a gradient, Respiratory Distress Score (RDS); (0=no distress, 1=tachypnea, 2-tachypnea and retractions), hospital and PCCU length of stay (LOS), need for mechanical ventilation/CPAP, and the presence of pleural effusion (PEF). Data were analyzed using the Student's t-test and Chi-square analysis. Results: 16 patients were treated for 19 episodes of ACS. 7 (44%) were male and 9 (56%) were female. 10 pts received ST (Grp 1) and 9 ET (Grp 2) The mean age was 10.4 years. Results are presented as the mean ±standard error. ST ET p PRISM 3.3±0.5 5.4±1.2 .09 A-a 384±58 280±48 .18 Hb 8.4±0.5 7.3±0.4 .11 RDS 1.5±.22 1.9±.11 .15 ICU LOS 2.6±0.4 5.6±1.2 .03 Hosp LOS 11.9±3 11.8±1.7 .96 MV 2 (20%) 5 (55.6%) .11 PEF 3 (30%) 7 (77.8%) .04 Conclusions: There was no difference between the Crps in Hb, PRISM, A-a gradient, RDS, H LOS, or the need for MV/CPAP. Despite a similar clinical severity, pts in Grp 2 (ET) had a longer PICU LOS. ET does not however appear superior to ST in hastening clinical improvement in children with ACS. A prospective study is needed.