Background

Acute chest syndrome (ACS) is the main cause of morbi-mortality in patients with sickle-cell disease in the intensive care unit (ICU). ACS definition encompasses many types of lung damage, making early detection of the most severe forms challenging. We aimed to describe ACS-related lung ultrasound (LU) patterns and determine LU performance to assess ACS outcome.

Results

We performed a prospective cohort study including 56 ICU patients hospitalized for ACS in a tertiary university hospital (Paris, France). LU and bedside spirometry were performed at admission (D0) and after 48 h (D2). Complicated outcome was defined by the need for transfusion of ≥ 3 red blood cell units, mechanical ventilation, ICU length-of-stay > 5 days, or death. A severe loss of lung aeration was observed in all patients, predominantly in inferior lobes, and was associated with decreased vital capacity (22 [15–33]% of predicted). The LU Score was 24 [20–28] on D0 and 20 [15–24] on D2. Twenty-five percent of patients (14/56) had a complicated outcome. Neither oxygen supply, pain score, haemoglobin, LDH and bilirubin values at D0; nor their change at D2, differed regarding patient outcome. Conversely, LU re-aeration score and spirometry change at D2 improved significantly more in patients with a favourable outcome. A negative LU re-aeration score at D2 was an independent marker of severity of ACS in ICU.

Conclusions

ACS is associated with severe loss of lung aeration, whose resolution is associated with favourable outcome. Serial bedside LU may accurately and early identify ACS patients at risk of complicated outcome.

中文翻译：

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肺通气的形态功能评估，作为ICU中镰状细胞急性胸部综合征严重程度的标志：一项前瞻性队列研究。

背景

重症监护病房（ICU）的镰状细胞病患者中，急性胸腔综合征（ACS）是导致病死率的主要原因。ACS的定义涵盖了多种类型的肺部损伤，这使得对最严重形式的早期检测具有挑战性。我们旨在描述ACS相关的肺部超声（LU）模式并确定LU表现以评估ACS结果。

结果

我们进行了一项前瞻性队列研究，包括一所大学医院（法国巴黎）中接受ACS住院治疗的56位ICU患者。在入院时（D0）和48小时后（D2）进行LU和床旁肺量测定。复杂结局定义为需要输注≥3个红细胞，机械通气，ICU住院时间> 5天或死亡。在所有患者中均观察到严重的肺通气严重丧失，主要发生在下叶，并且与肺活量降低有关（占预测值的22 [15–33]％）。LU得分在D0上为24 [20–28]，在D2上为20 [15-24]。25％（14/56）的患者预后复杂。D0时氧气供应，疼痛评分，血红蛋白，LDH和胆红素值均无变化；它们在D2时的变化也不相同，关于患者预后的差异也不同。反过来，结果良好的患者，D2时的LU通气评分和肺活量改变明显改善。D2时LU再通气评分为阴性是ICU中ACS严重程度的独立指标。

结论

ACS与严重的肺通气丧失有关，其消失与良好的预后有关。连续床旁LU可以准确，早期地识别出有复杂结果风险的ACS患者。