PMID- 10022169
OWN - NLM
STAT- MEDLINE
DCOM- 19990413
LR  - 20190710
IS  - 0022-3468 (Print)
IS  - 0022-3468 (Linking)
VI  - 34
IP  - 1
DP  - 1999 Jan
TI  - Acute chest syndrome in the postoperative sickle cell patient.
PG  - 188-91; discussion 191-2
AB  - BACKGROUND/PURPOSE: Acute chest syndrome (ACS), a phenomenon of pulmonary 
      sequestration in sickle cell disease (SCD) patients, is frequently missed in the 
      postoperative SCD child. The constellation of symptoms range from fever and 
      respiratory distress to abdominal discomfort. In its most fulminate state, the 
      syndrome has been reported in some series to carry almost a 25% to 50% mortality 
      rate in the postoperative patient. The incidence in pediatric patients in the era 
      of minimally invasive surgery is unknown. METHODS: Since December 1995, 63 
      episodes of ACS have been documented in the nearly 500 SCD children seen at our 
      institution. Six of 63 episodes occurred within 2 weeks after a surgical 
      procedure under general anesthesia. During this period, 59 operations were 
      performed by the pediatric surgery service on SCD patients with an ACS incidence 
      of 10.2%. Careful review of the preoperative, intraoperative, and postoperative 
      management of these patients was performed. RESULTS: All six received 
      preoperative oxygen saturation monitoring and intravenous fluid (IVF) hydration. 
      One half of these patients required transfusion to achieve a hemoglobin level of 
      greater than 10 mg/dL. Documentation of intraoperative temperature, hypoxia, 
      volume status, and hypercarbia as well as any atypical perioperative events were 
      monitored and reviewed. All patients received postoperative oxygen 
      supplementation and IVF hydration. Onset of ACS ranged from 1 hour to 7 days 
      postoperatively. Only one of six was thought to be of microbial etiology 
      (elevated mycoplasma titers), and all patients received prophylactic antibiotic 
      and aggressive pulmonary therapy. Overall length of hospitalization was increased 
      with an average stay of 6.1 days. There were no postsurgical ACS deaths. 
      CONCLUSIONS: Despite close attention and avoidance of known risk factors for 
      development of postoperative SCD complications, ACS occurred with an incidence 
      much higher than previously reported in the literature (0.4% v 10.2%). 
      Interestingly, five of six cases were after laparoscopic procedures suggesting 
      that the advantages of laparoscopy, such as reduced postoperative pain, do not 
      extrapolate to decreased incidence of ACS.
FAU - Delatte, S J
AU  - Delatte SJ
AD  - Department of Surgery, Medical University of South Carolina, Charleston 29425, 
      USA.
FAU - Hebra, A
AU  - Hebra A
FAU - Tagge, E P
AU  - Tagge EP
FAU - Jackson, S
AU  - Jackson S
FAU - Jacques, K
AU  - Jacques K
FAU - Othersen, H B Jr
AU  - Othersen HB Jr
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
SB  - IM
MH  - Adolescent
MH  - Anemia, Sickle Cell/*surgery
MH  - Bronchopulmonary Sequestration/*etiology/therapy
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Infant
MH  - Male
MH  - *Postoperative Complications
MH  - Retrospective Studies
MH  - Syndrome
EDAT- 1999/02/18 03:02
MHDA- 2001/03/28 10:01
CRDT- 1999/02/18 03:02
PHST- 1999/02/18 03:02 [pubmed]
PHST- 2001/03/28 10:01 [medline]
PHST- 1999/02/18 03:02 [entrez]
AID - S0022-3468(99)90254-3 [pii]
AID - 10.1016/s0022-3468(99)90254-3 [doi]
PST - ppublish
SO  - J Pediatr Surg. 1999 Jan;34(1):188-91; discussion 191-2. doi: 
      10.1016/s0022-3468(99)90254-3.