Morpho-functional evaluation of lung aeration as a marker of sickle-cell acute chest syndrome severity in the ICU: a prospective cohort study

Garnier, Marc; Hafiani, El Mahdi; Arbelot, Charlotte; Blayau, Clarisse; Stankovic‐Stojanovic, Katia; Lionnet, François; Bonnet, Francis; Fulgencio, Jean-Pierre; Fartoukh, Muriel; Quesnel, Christophe

doi:10.1186/s13613-019-0583-y

Cited by 5 publications

(4 citation statements)

References 40 publications

(63 reference statements)

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“…When RBC transfusion was considered during a VOE, but the indication is not clear-cut (in clinical practice, when the interpretability of the child-reported pain score is difficult), then the analysis of leukocyte count and CRP level at day 2 may help in a decision. Interestingly, a recent study performed in adult patients with severe ACS hospitalized in intensive care unit, comparing ACS-related lung ultrasound patterns at admission and after 48 h reported that the evolution of lung aeration during the first two days was strongly associated with outcome events occurring beyond this time point [34]. Early detection of patients who will experience a complicated outcome during VOE and ACS is a major concern, since it would allow physicians to modify their management accordingly.…”

Section: Discussionmentioning

confidence: 99%

Identification of Clinical and Laboratory Parameters Associated with the Development of Acute Chest Syndrome during Vaso-Occlusive Episodes in Children with Sickle Cell Disease: A Preliminary Step before Assessing Specific and Early Treatment Strategies

Madhi

Kamdem

Jung

et al. 2019

JCM

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This prospective observational study sought to ascertain clinical and laboratory parameters associated with the development of acute chest syndrome (ACS) during vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD). It was performed at the pediatric department of the university Intercommunal Créteil hospital. All children with SCD (all sickle genotypes) consecutively admitted from November 2013 to December 2016 for painful VOEs and no evidence of ACS were included. Clinical and laboratory parameters collected at admission and within 48 h after admission were compared for children in whom ACS developed or not. Variables that were statistically significant on univariate analysis or considered to be clinically relevant were included in a multivariable model to ascertain the risk factors associated with the development of ACS during a VOE. The variables retained in the multivariate model were used to construct a predictive score for ACS. For each included child and during the study period, only data from the first VOE and/or the first ACS were analyzed. Among 191 hospitalizations for painful VOEs, for 176 children with SCD, ACS developed in 35 during hospitalization. Mean hospital stay was longer for children with ACS versus VOEs alone (7.6 (±2.3) vs. 3.3 (±1.8) days, p < 0.0001), and all children with ACS versus 28/156 (17.9%) with VOEs alone received red blood cell transfusion (p < 0.0001). The multivariate model retained pain score (≥9/10), pain localization (abdominal or spinal pain or involving more than two limbs), and high reticulocyte (≥260 × 109/L) and neutrophil (>10 × 109/L) counts, at admission, as independently associated with ACS development. The area under the receiver operating characteristic curve for the ACS predictive score was 0.82 (95% CI: 0.74–0.89), and the negative predictive value was 97.7%. The evolution profiles during the first 48 h differed between children with ACS and VOEs alone, with a more rapid decline of pain score and leucocytosis in children with VOEs. Clinical and laboratory measurements at admission may be simple parameters to identify children with increased risk of ACS development during VOEs and to facilitate early diagnosis of this respiratory complication. Also, the persistent elevation of leukocyte count on day 2 may be considered a sign of evolving ACS.

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Section: Discussionmentioning

confidence: 99%

Identification of Clinical and Laboratory Parameters Associated with the Development of Acute Chest Syndrome during Vaso-Occlusive Episodes in Children with Sickle Cell Disease: A Preliminary Step before Assessing Specific and Early Treatment Strategies

Madhi

Kamdem

Jung

et al. 2019

JCM

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“…Here, we report for the first time an association between sputum IL‐6 level measured within the first days of hospitalisation for ACS and ACS severity. ACS is one of the most severe acute complications of SCD with high morbimortality and prolonged hospitalisation length 1,2,10 . To date, very few studies have tried to identify early markers of ACS severity 4,11 .…”

Section: Resultsmentioning

confidence: 99%

“…ACS is one of the most severe acute complications of SCD with high morbimortality and prolonged hospitalisation length. 1,2,10 To date, very few studies have tried to identify early markers of ACS severity. 4,11 Plasma levels of secretory phospholipase A2 were found associated with hypoxia during ACS, but investigations regarding this inflammatory mediator as a potential marker of ACS severity have not been conducted further.…”

Section: Sputum Il-6 Levels Are Significantly Higher In Patients With...mentioning

confidence: 99%

Sputum interleukin‐6 level as a marker of severity during acute chest syndrome in children with sickle cell disease

Mayrand,

Elie,

Pinhas

et al. 2024

Br J Haematol

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SummaryAcute chest syndrome (ACS) is a leading cause of morbimortality in sickle cell disease (SCD). In this prospective observational study, we investigated sputum interleukin‐6 (IL‐6) level as an ACS severity marker during 30 ACS episodes in 26 SCD children. Sputum IL‐6 levels measured within the first 72 h of hospitalisation for ACS were significantly higher in patients with oxygen requirement ≥2 L/min, ventilation (invasive and/or non‐invasive) length ≥5 days, bilateral and/or extensive opacities on chest X‐ray or erythrocytapheresis requirement. Sputum IL‐6 could serve as an ACS severity marker to help identify patients requiring targeted anti‐inflammatory treatments such as tocilizumab.

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“…In SCD patients, occlusion of the small blood vessels presents as episodes of severe pains that called vasoocclusive crisis (VOC), which damage to the vital organs. Some patients develop acute chest syndrome (ACS), a major cause of death in SCD (132). iNO has positive effect in the pathophysiological and therapeutic in case series of ACS patients (133).…”

Section: Sickle Cell Disease (Scd)mentioning

confidence: 99%

Inhaled pulmonary vasodilators: a narrative review

Li¹,

Wang²,

Yu³

et al. 2021

Ann Transl Med

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Pulmonary hypertension (PH) is a severe disease that affects people of all ages. It can occur as an idiopathic disorder at birth or as part of a variety of cardiovascular and pulmonary disorders. Inhaled pulmonary vasodilators (IPV) can reduce pulmonary vascular resistance (PVR) and improve RV function with minimal systemic effects. IPV includes inhaled nitric oxide (iNO), inhaled aerosolized prostacyclin, or analogs, including epoprostenol, iloprost, treprostinil, and other vasodilators. In addition to pulmonary vasodilating effects, IPV can also be used to improve oxygenation, reduce inflammation, and protect cell.Off-label use of IPV is common in daily clinical practice. However, evidence supporting the inhalational administration of these medications is limited, inconclusive, and controversial regarding their safety and efficacy. We conducted a search for relevant papers published up to May 2020 in four databases: PubMed, Google Scholar, EMBASE and Web of Science. This review demonstrates that the clinical using and updated evidence of IPV. iNO is widely used in neonates, pediatrics, and adults with different cardiopulmonary diseases. The limitations of iNO include high cost, flat dose-response, risk of significant rebound PH after withdrawal, and the requirement of complex technology for monitoring. The literature suggests that inhaled aerosolized epoprostenol, iloprost, treprostinil and others such as milrinone and levosimendan may be similar to iNO. More research of IPV is needed to determine acceptable inclusion criteria, long-term outcomes, and management strategies including time, dose, and duration.

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Morpho-functional evaluation of lung aeration as a marker of sickle-cell acute chest syndrome severity in the ICU: a prospective cohort study

Cited by 5 publications

References 40 publications

Identification of Clinical and Laboratory Parameters Associated with the Development of Acute Chest Syndrome during Vaso-Occlusive Episodes in Children with Sickle Cell Disease: A Preliminary Step before Assessing Specific and Early Treatment Strategies

Identification of Clinical and Laboratory Parameters Associated with the Development of Acute Chest Syndrome during Vaso-Occlusive Episodes in Children with Sickle Cell Disease: A Preliminary Step before Assessing Specific and Early Treatment Strategies

Sputum interleukin‐6 level as a marker of severity during acute chest syndrome in children with sickle cell disease

Inhaled pulmonary vasodilators: a narrative review

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