Place of thoracic ultrasound in the management of sickle cell disease patients admitted to the ICU

Position du problème et objectif(s) de l’étude

Sickle cell disease (SCD) is the most prevalent monogenic recessive disorder worldwide. Its prevalence in France is steadily increasing, with more than 19,000 patients diagnosed in 2018. SCD, particularly common in overseas territories, leads to a variety of complications, with acute chest syndrome (ACS) being the leading cause of mortality. ACS results from pulmonary vaso-occlusion, predominantly caused by fat emboli originating from the bone marrow. Traditional imaging techniques, such as chest radiography and CT, often have limitations in sensitivity and are associated with radiation exposure and nephrotoxicity. Chest ultrasound, however, offers a non-invasive, accessible, and cost-effective alternative. This observational study aimed to evaluate the diagnostic value of chest ultrasound in critically ill SCD patients, comparing it with traditional imaging methods.

Matériel et méthodes

We conducted a retrospective study at the University Hospital of Guadeloupe's critical care unit. We included patients aged 18 or older with a confirmed diagnosis of major sickle cell syndrome, admitted for ACS or vaso-occlusive crisis (VOC) between November 2023 and April 2024. Patients underwent chest ultrasound, radiography, and CT scan. Ultrasound findings were analyzed according to the BLUE protocol, identifying pleural effusions, alveolar consolidations, and signs of pulmonary embolism.

Résultats & Discussion

A total of 72 patients were assessed, with 33 (45.8%) undergoing chest ultrasound. Ultrasound demonstrated superior diagnostic performance compared to radiography, with a sensitivity of 85% and specificity of 92%. The area under the curve (AUC) for ultrasound was 0.85, while radiography had an AUC of 0.66. A significant correlation (Pearson’s r = 0.68) was found between ultrasound and CT scan findings, with pulmonary consolidations predominantly located in the basal regions of the lungs. Ultrasound also identified signs of pulmonary embolism in two patients, which were confirmed by CT. Chest ultrasound emerged as a valuable diagnostic tool in critically ill SCD patients, showing superior sensitivity and specificity compared to chest radiography. Its ability to detect early pulmonary anomalies, such as consolidations and pleural effusions, makes it an essential tool in the management of ACS. Ultrasound is particularly advantageous in resource-limited settings due to its accessibility, lower cost, and absence of radiation exposure. Additionally, it enables real-time monitoring and more rapid intervention, which is crucial in critical care.

Conclusion

Chest ultrasound is a promising, cost-effective, and non-invasive diagnostic modality for managing acute chest syndrome in critically ill sickle cell patients. It offers significant advantages over traditional radiographic imaging, particularly in resource-constrained settings. Further large-scale prospective studies are needed to validate these findings and refine clinical management strategies for SCD patients in critical care.

Auteurs

Elsa VIDAL, Athanase RÉMY, Robin DELERIS, Amélie ROLLÉ - (1)Chu De La Guadeloupe, Guadeloupe, France

Orateur(s)

Elsa VIDAL (Le gosier)