Sickle cell anaemia: acute chest syndrome: fewer lung changes were seen on chest x-ray with regular deep breathing.

Clinical bottom line (level 1b)

  1. Sickle cell patients with acute chest pain had fewer pulmonary complications if they breathe deeply every two hours when awake (NNT = 3 at 3 days) .
Bellet et al: New England Journal of Medicine 1995; 333 (11): 699-703
Expires April 2004

The study

Unblinded concealed randomised trial without intention-to-treat
Setting: children's hospital, USA

29 patients (aged range 8 to 21 years; mean ~16, 50% male) sickle cell anaemia admitted with acute chest or back pain above the diaphragm

Excluded if
  • aged <7 years
  • chest x-ray changed since previous film


    • Note:
  • Patients were treated as new individuals at each admission, therefore there were 38 episodes in 29 patients.


    • Control Group: (n = 19, 19 analysed): standard care alone: narcotics and NSAIDs prn; i.v. fluids 5% dextrose with 0.45% saline at 1-1.5 maintenance dose for at least 24 hours; antibiotics if temperature >38 ° C and suspected bacterial infection; blood transfusion if haemoglobin <6 g/dl
    Experimental Group: (n = 19, 19 analysed): standard care plus incentive spirometry every two hours from 8 am to 10 pm, and at night if awake, until chest pain settled. Patients were asked to perform ten maximal inspirations.
    All patients had a chest x-ray on admission and at three days (or sooner if clinically indicated). Some patients had a bone scan (39%).
    100% followed for 3 days
    Outcome notes:
    • pulmonary complication : atelectasis or infiltrates

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    pulmonary complication 3 days 8
    (42.1%)    		 1
    (5.26%)    		 88%
    (10% to 98%)    		 36.8%
    (12.5% to 61.2%)    		 3
    (2 to 8)

    Comments

    1. How closely do the changes on chest x-ray relate to lung pathology of concern?

    Citation

    1. Bellet PS, Kalinyak KA, Shutla R, et al: Incentive spirometry to prevent acute pulmonary complications in sickle cell diseases. New England Journal of Medicine 1995; 333 (11): 699-703
    Contributor: Chris Ball and Clare Wotton, April 2000
    Reviewer: Mona Nabulsi

    Clinical Question.
    Patient sickle cell anaemia
    Intervention or Exposure incentive spirometry
    Comparison standard care alone
    Outcome pulmonary complication