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Previous Volume 333:699-703 September 14, 1995 Number 11 Next

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ABSTRACT

Background This study was designed to determine the incidence of thoracic bone infarction in patients with sickle cell diseases who were hospitalized with acute chest or back pain above the diaphragm and to test the hypothesis that incentive spirometry can decrease the incidence of atelectasis and pulmonary infiltrates.

Methods We conducted a prospective, randomized trial in 29 patients between 8 and 21 years of age with sickle cell diseases who had 38 episodes of acute chest or back pain above the diaphragm and were hospitalized. Each episode of pain was considered to be an independent event. At each hospitalization, patients with normal or unchanged chest radiographs on admission were randomly assigned to treatment with spirometry or to a control nonspirometry group. Each patient in the spirometry group took 10 maximal inspirations using an incentive spirometer every two hours between 8 a.m. and 10 p.m. and while awake during the night until the chest pain subsided. A second radiograph was obtained three or more days after admission, or sooner if clinically necessary, to determine the incidence of pulmonary complications. Bone scanning was performed no sooner than two days after hospital admission to determine the incidence of thoracic bone infarction.

Results The incidence of thoracic bone infarction was 39.5 percent (15 of 38 hospitalizations). Pulmonary complications (atelectasis or infiltrates) developed during only 1 of 19 hospitalizations of patients assigned to the spirometry group, as compared with 8 of 19 hospitalizations of patients in the nonspirometry group (P = 0.019). Among patients with thoracic bone infarction, no pulmonary complications developed in those assigned to the spirometry group during a total of seven hospitalizations, whereas they developed during five of eight hospitalizations in the nonspirometry group (P = 0.025).

Conclusions Thoracic bone infarction is common in patients with sickle cell diseases who are hospitalized with acute chest pain. Incentive spirometry can prevent the pulmonary complications (atelectasis and infiltrates) associated with the acute chest syndrome in patients with sickle cell diseases who are hospitalized with chest or back pain above the diaphragm.

Source Information

From the Division of General Pediatrics (P.S.B.), the Division of Hematology–Oncology and the Cincinnati Comprehensive Sickle Cell Center (K.A.K., D.L.R.), and the Department of Radiology (M.J.G.), Children's Hospital Medical Center; and the Department of Environmental Health, Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine (R.S.) — all in Cincinnati.

Address reprint requests to Dr. Bellet at the Department of Pediatrics, Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039.

Full Text of this Article

Related Letters:

Incentive Spirometry in Sickle Cell Crisis
Merrill W. W., Bellet P. S., Kalinyak K. A., Rucknagel D. L.
Extract | Full Text  
N Engl J Med 1996; 334:124-125, Jan 11, 1996. Correspondence

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