The use of incentive spirometry in pediatric patients with sickle cell disease to reduce the incidence of acute chest syndrome

J Pediatr Hematol Oncol. 2011 Aug;33(6):415-20. doi: 10.1097/MPH.0b013e31821ed4ce.


Introduction: To determine if incentive spirometry (IS) in pediatric patients admitted with sickle cell disease for nonrespiratory complaints will decrease acute chest syndrome (ACS).

Methods: This was an Institutional Review Board-approved before-after 2-year retrospective cohort study evaluating an evidence-based guideline (EBG) initiating mandatory IS in admitted pediatric sickle cell patients from a tertiary children's emergency center. Student t testing and χ² analysis were performed.

Results: There were 1551 patient visits. About 258 visits were enrolled in the pre-EBG year, and 230 in the EBG year. Between year characteristics were similar. The EBG year reported higher use of hydroxyurea (P<0.01), analgesics (P=0.02), and chest pain (P=0.03). Sixty-seven patients (25.9%) in the pre-EBG year received transfusions versus 51 (22.5%) in the EBG year (NS). Twenty-five (9.6%) of the pre-EBG patients received blood for ACS versus 14 (6.1%) in the EBG group (absolute risk reduction: 3.5%, 95% confidence interval: -1-8.4%). Subgroup analysis revealed that patients who presented with back pain experienced a significant decrease in the development of ACS in the EBG year (P=0.04, absolute risk reduction: 14%, 95% confidence interval: 1-28%, number needed to treat: 8).

Conclusion: Mandatory IS for sickle cell disease patients admitted without respiratory complaints reduces transfusions and ACS, particularly for those presenting with back pain.

MeSH terms

  • Acute Chest Syndrome / diagnosis*
  • Acute Chest Syndrome / etiology
  • Acute Chest Syndrome / prevention & control*
  • Adolescent
  • Anemia, Sickle Cell / complications*
  • Anemia, Sickle Cell / therapy
  • Child
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Male
  • Prognosis
  • Retrospective Studies
  • Spirometry