Acute Chest Syndrome - Essay Example

Acute Chest Syndrome Acute Chest Syndrome Background Acute Chest Syndrome (ACS) is a disease common among patients of sickle cell disease (SCD) and is characterized by an acute pulmonary illness (Bernard, Yasin, and Venkat, 2007). The disease is essentially lung-based and the characteristic symptom of sickle cell anemia, that is, the reduction of blood oxygen level can threaten the life of its patients. In a chest radiograph or x-ray, ACS is identified on the basis of a new infiltrate along with the presence of one other symptom, namely chest pain, cough, wheezing, tachypnea, and/or fever (Bernard, Yasin, and Venkat, 2007; Johnson, 1995). The condition is unique in its nature and can be caused by both infectious and non-infectious processes. Thus, its diagnosis procedures and treatment involves methods that are atypical of other pulmonary illnesses. The disease has been a significant cause of death among hospitalized patients suffering from sickle cell anemia, which is why ACS is considered to be an important disease. Its symptomatic representation includes fever and coughing among children while adults present the symptoms of chest pain, panting, and chills (Bernard, Yasin, and Venkat, 2007). The symptomatic representations are complex in ACS and not all symptoms may present themselves in every episode of ACS (Johnson, 1995). On the other hand, diagnostic procedures may involve the examination of a combination of such symptoms in order to make a conclusive judgement. According to Bernard, Yasin and Venkat (2007), its treatment may involve the providence of supportive care, administration of broad spectrum antibiotics, incentive spirometry, and so on. Patients may also be hospitalized if the level of pain experienced by them increases. Diagnosis Since, ACS is a result of a range of causes, no particular test has been identified to be a definite diagnosis (Johnson, 1995). However, a chest radiography or a chest x-ray remains to be an unparalleled diagnostic test for ACS. A new infiltrate on the chest x-ray is revealed upon a positive radiographic test which involves the lower lobe, although the involvement of the lower lobe does not indicate any typical connection since any lobe can be affected. Multiple lobes can also be involved as well as the presence of effusions (Bernard, Yasin, and Venkat, 2007). However, the chest radiography method has presented a few limitations among which are the admission of a patient into a hospital and the subsequent development of the new infiltrate. Also, many times, the degree of the disease’s severity as well as the extent of hypoxia is left unnoticed in the initial studies and it takes several tests before this is realized. Thus, radiography also displays certain shortcomings. However, a serial radiography is often helpful in aiding the diagnostic procedure. The method of chest radiography has proven to progress with time though its is a useful form of clinical assessment used in order to identify ACS. Chest radiography, as a diagnostic procedure, involves regular documentation of the findings so as to aid the clinical evaluation of the disease as well as the changes that are undertaking within. With improvements in technology, advanced radiographic techniques have also been introduced. However, the use of such a radiographic imaging has been limited although it can provide useful information regarding the patient’s condition. Similar, there is V/Q imaging that can help in cases where the radiography presents a normal x-ray while the hypoxia seems to be worsening. Previous documented history of a particular patient’s illness compliments the V/Q imaging however undocumented events of the past may complicate the employment of V/Q imaging. Another method of diagnosis involves an examination of the sputum and blood cultures so as to look for infectious etiologies that may have caused the disease. Blood cultures and bronchoscopy allow the identification of bacteria that may be behind causing the disease. However, historically, the sue of blood cultures has shown to be positive for only 3.5 percent of ACS patients. Johnson (1995) had still suggested the use of this technique so as to identify the presence of pathogenic microorganisms. Bronchoscopy and Broncho-Alveolar Lavage (BAL), relatively provides a high quality diagnostic test as compared to blood cultures in identifying microorganisms. Thus, the diagnosis of acute chest syndrome involves various diagnostic procedures, among which the chest radiography appears to be the most commonly used. However, innovations in technology have given rise to other imaging methods that may prove useful in certain cases. Also, the previous methods of blood cultures and bronchoscopy may also provide useful information. So this leads the clinician to several options when considering the diagnostic tests for ACS. Treatment The symptoms of ACS are severe and progressive over time. It has been realized that the causative factors for ACS are multiple and that its etiology involves bacterial infections and Pulmonary Fat Embolism (PFE). To a great extent, the treatment of ACS is backed up by clinical findings of the disease and other reports that help its treatment. Death from ACS has been low, both in adults and children. However, these low figures for the mortality rates do not imply an ease in treatment of ACS. The diagnostic tests are variable however even with such information, it is often difficult to judge the degree of severity of the disease among patients or the extent to which the hypoxemia is life threatening. The treatment of ACS is mainly supportive in nature (Paul, Castro, Agarwal, and Oneal, 2011). Supportive care usually mitigates the harmful effects of ACS, reduces its severity and circumvents death. Patients with hypoxemia are generally treated with pulse oximetry and by delivering supplemental oxygen. Treatment for other patients involves pain management, empiric antimicrobial therapy, hemoglobin concentration monitoring, blood transfusion, and so on. Pain management in a sufficient manner is extremely important in order to prevent hypoventilation. Opioid analgesia is involved in pain management as it can produce respiratory depressions thereby risking its attendant of hypoxia while also escalating pulmonary varo occlusion (Paul, Castro, Agarwal, and Oneal, 2011). Pain control is also aimed at preventing thoracic splinting and promoting good pulmonary toilet. The first 48 hours are extremely important during treatment as the patient’s respiration is continuously being monitored in order to see the deterioration in respiration and the need for any artificial form of ventilation. Supplemental oxygen is reserved for patients with hypoxia. Hydration is also kept in control as excessive hydration may have negative consequences as the pulmonary status deteriorates (Bernard, Yasin, and Venkat, 2007). Patients suffering from ACS are also administered antibiotics, usually broad spectrum antibiotics such as third-generation cephalosporin. The results obtained from blood cultures as well as the risk factors from the virulent microorganisms can help guide the treatment therapy. But since blood cultures have proved to incorporate certain limitations, antibiotics should be given to the patients regardless of the blood culture report. In ACS patients with hypoxia, blood transfusion (simple and exchange) is used to increase oxygenation. In patients with severe hypoxia and those requiring mechanical ventilation, an exchange transfusion has shown to be more effective (Paul, Castro, Agarwal, and Oneal, 2011). Bronchodilators are also used in the treatment of ACS since it is considered to involve an airway component that responds to treatment. Bernard, Yasin, and Venkat (2007) suggest that this could be due to the high prevalence of asthmatic patients also suffering from sickle cell anemia. Patients have shown to improve in their conditions after the administration of bronchodilators. Treatment with bronchodilators has been recommended regardless of wheezing as a way to see if a response is generated to the treatment and should be continued throughout the treatment process. References Bernard, A., Yasin, Z., & Venkat, A. (2007). Acute chest syndrome of sickle cell disease.Hospital Physician, 44, 15--23. Johnson, C. S. (1995). Acute Chest Syndrome: Sickle Cell Disease. Information Center for Sickle Cell and Thelassemic Disorders. Retrieved 24 May 2014, from http://sickle.bwh.harvard.edu/acutechest.html Paul, R., Castro, O., Aggarwal, A., & Oneal, P. (2011). Acute chest syndrome: sickle cell disease. European Journal Of Haematology, 87(3), 191--207. Read More