INCENTIVE SPIROMETRY TO PREVENT ACUTE PULMONARY COMPLICATIONS IN SICKLE-CELL DISEASES

Background. This study was designed to determine the incidence of thor acic bone infarction in patients with sickle cell diseases who were ho spitalized with acute chest or back pain above the diaphragm and to te st the hypothesis that incentive spirometry can decrease the incidence of atelectasis and pulmonary infiltrates. Methods. We conducted a pro spective, randomized trial in 29 patients between 8 and 21 years of ag e 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, pa tients with normal or unchanged chest radiographs on admission were ra ndomly assigned to treatment with spirometry or to a control nonspirom etry group. Each patient in the spirometry group took 10 maximal inspi rations using an incentive spirometer every two hours between 8 a.m. a nd 10 p.m. and while awake during the night until the chest pain subsi ded. A second radiograph was obtained three or more days after admissi on, or sooner if clinically necessary, to determine the incidence of p ulmonary 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 wa s 39.5 percent (15 of 38 hospitalizations). Pulmonary complications (a telectasis or infiltrates) developed during only 1 of 19 hospitalizati ons of patients assigned to the spirometry group, as compared with 8 o f 19 hospitalizations of patients in the nonspirometry group (P = 0.01 9). Among patients with thoracic bone infarction, no pulmonary complic ations developed in those assigned to the spirometry group during a to tal of seven hospitalizations, whereas they developed during five of e ight hospitalizations in the nonspirometry group (P = 0.025). Conclusi ons. Thoracic bone infarction is common in patients with sickle cell d iseases who are hospitalized with acute chest pain, Incentive spiromet ry can prevent the pulmonary complications (atelectasis and infiltrate s) associated with the acute chest syndrome in patients with sickle ce ll diseases who are hospitalized with chest or back pain above the dia phragm.