Respiratory Therapy) (A57225)
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Acute Chest Syndrome in Sickle Cell Disease Care Guideline
Acute Chest Syndrome in Sickle Cell Disease Care Guideline Inclusion Criteria: · Children with sickle cell disease Recommendations/ · New pulmonary infiltrate on CXR, involving at least one Considerations complete lung segment, excluding atelectasis Predictors: · Pain crisis involving chest, shoulders Assessment and back · Admit to 5S or PICU · Post anesthesia complication · NPO · Respiratory Infections · History and physical with focus on pulmonary exam · On narcotics · Vitals, accurate height and weight · Asthma exacerbation · Strict I/O; Daily Weight · O2 saturation · Baseline Hgb level may run low < · Diagnostics: 9gm/dl CBC with retic, CMP with LDH, STAT type and screen, Hgb electrophoresis · If suspected pulmonary embolism, · Consider VBG for significant respiratory distress obtain CT angiogram of chest · CXR 2 view · Blood culture if fever >38, elevated WBC · May need more than 1 exchange · VRP if URI symptoms transfusion if clinical findings not improving Interventions · After recovery from acute crisis, pt · Stat Hematology consult (if not admitted to Hematology service) should be started on hydroxyurea if · Pulmonary consult not already taking; optimize dose · Notify apheresis team as soon as possible during working hours if anticipated procedure · History of more than 1 acute chest · Consult PICU for possible apheresis catheter placement crisis, consider chronic transfusion · Oxygen to keep O2 sat >=94% protocols to keep HgbS < 25% · Maintenance IV fluids · Antibiotics: ceftriaxone and azithromycin · If recurrent crises, consider -
Local Coverage Determination for Respiratory Therapy
Local Coverage Determination (LCD): Respiratory Therapy (Respiratory Care) (L34430) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor Name Contract Type Contract Number Jurisdiction State(s) Palmetto GBA A and B MAC 10111 - MAC A J - J Alabama Palmetto GBA A and B MAC 10211 - MAC A J - J Georgia Palmetto GBA A and B MAC 10311 - MAC A J - J Tennessee Palmetto GBA A and B and HHH MAC 11201 - MAC A J - M South Carolina Palmetto GBA A and B and HHH MAC 11301 - MAC A J - M Virginia Palmetto GBA A and B and HHH MAC 11401 - MAC A J - M West Virginia Palmetto GBA A and B and HHH MAC 11501 - MAC A J - M North Carolina Back to Top LCD Information Document Information LCD ID Original Effective Date L34430 For services performed on or after 10/01/2015 Original ICD-9 LCD ID Revision Effective Date L31593 For services performed on or after 01/29/2018 Revision Ending Date LCD Title N/A Respiratory Therapy (Respiratory Care) Retirement Date Proposed LCD in Comment Period N/A N/A Notice Period Start Date Source Proposed LCD 08/18/2016 N/A Notice Period End Date AMA CPT / ADA CDT / AHA NUBC Copyright Statement 10/02/2016 CPT only copyright 2002-2018 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. -
Acute Chest Syndrome
CLINICAL PATHWAY PEDIATRIC ACUTE CHEST SYNDROME (ACS) Patients with sickle cell disease presenting with 1) a new pulmonary infiltrate on chest radiography AND 2) evidence of lower airway disease (e.g. cough, shortness of breath, retractions, rales, etc.) TABLE OF CONTENTS Algorithm- N/A Target Population Background | Definitions Initial Evaluation-N/A Clinical Management Diagnostic Tests Fluids | Nutrition Respiratory Therapy Table 1. Pediatric Asthma Score Treatment Table 2. Antimicrobial Medication Table 3. Pain Medication Table 4. Respiratory Medication Discharge Criteria Related Children’s Hospital Colorado Documents References Clinical Improvement Team TARGET POPULATION Inclusion Criteria • Patients with sickle cell disease (SS, SC, Sβ0 thalassemia, Sβ+ thalassemia) • Patients of all ages • Patients treated year round Exclusion Criteria • Patients without infiltrate on chest radiograph (e.g. asthma exacerbation) • Patients with severe pulmonary hypertension • Patients post bone marrow transplant • Well children with pneumonia Page 1 of 10 CLINICAL PATHWAY BACKGROUND | DEFINITIONS Acute chest syndrome (ACS) is the second most common reason for hospitalization in children with sickle cell disease and a leading cause of mortality. ACS is defined as a new pulmonary infiltrate on chest radiograph in the presence of evidence of lower respiratory tract disease (e.g. some combination of cough, shortness of breath, retractions, rales, etc.). In the majority of cases of ACS, an etiology is unable to be identified. The most common identified etiology of ACS is infection but it may also result from pulmonary vaso-occlusion, pulmonary infarction or fat embolism. The primary infectious agents implicated in ACS include: Chlamydia pneumoniae, Mycoplasma pneumoniae, Streptococcus pneumoniae, and viruses. Risk factors for ACS include vaso-occlusive pain crisis, anesthesia, and surgery. -
Changes Seen on Computed Tomography of the Chest In
Alves UD et al.Original / CT of the Article chest in sickle cell disease Changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease* Alterações na tomografia computadorizada do tórax em pacientes adultos oligossintomáticos com doença falciforme Ursula David Alves1, Agnaldo José Lopes2, Maria Christina Paixão Maioli3, Andrea Ribeiro Soares3, Pedro Lopes de Melo4, Roberto Mogami5 Alves UD, Lopes AJ, Maioli MCP, Soares AR, Melo PL, Mogami R. Changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease. Radiol Bras. 2016 Jul/Ago;49(4):214–219. Abstract Objective: To describe and quantify the main changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease, as well as to evaluate the radiologist accuracy in determining the type of hemoglobinopathy. Materials and Methods: A prospective study involving 44 adult patients with sickle cell disease who underwent inspiration and expiration computed tomography of the chest. The frequency of tomography findings and the extent of involvement are reported. We also calculated radiologist accuracy in determining the type of hemoglobinopathy by analyzing the pulmonary alterations and morphology of the spleen. Results: The changes found on computed tomography scans, in descending order of frequency, were as follows: fibrotic opacities (81.8%); mosaic attenuation (56.8%); architectural distortion (31.8%); cardiomegaly (25.0%); lobar volume reduction (18.2%); and increased caliber of peripheral pulmonary arteries (9.1%). For most of the findings, the involvement was considered mild, five or fewer lung segments being affected. The accuracy in determining the type of hemoglobinopathy (HbSS group versus not HbSS group) was 72.7%. -
Predictors of Impending Acute Chest Syndrome in Patients with Sickle Cell
www.nature.com/scientificreports OPEN Predictors of impending acute chest syndrome in patients with sickle cell anaemia Salam Alkindi1,2*, Ikhlas Al-Busaidi1, Bushra Al-Salami1, Samir Raniga3, Anil Pathare 1 & Samir K. Ballas4 Acute chest syndrome (ACS) is a major complication of sickle cell anaemia (SCA) and a leading cause for hospital admissions and death. We aimed to study the spectrum of clinical and laboratory features of ACS and to assess the predisposing factors and predictors of severity. A retrospective case-control cohort was studied by retrieving patient information from electronic medical records after ethical approval. One hundred adolescents and adults with SCA and hospital admissions for ACS were identifed through the discharge summaries, along with 20 additional patients presenting with VOC, but without ACS (controls). Among the patients with ACS, fever (>38.5 °C), reduced oxygen saturation (<95) and asplenia signifcantly difered when compared to those of controls (p < 0.05, chi-squared test). The degree of severity was refected in the use of non-invasive ventilation (NIV), simple and exchange transfusions, and the presence of bilateral pleural efusions and multi-lobar atelectasis/consolidation, which were signifcantly higher in the cases with ACS than in the controls. Lower haemoglobin (Hb) and high WBC counts were also signifcantly diferent between the two groups (p < 0.05, Student’s t test). Using logistic regression, our study further demonstrated that asplenia, fever, and reduced O2 saturation, along with low Hb and leukocytosis, were important predictors for the development of ACS. Sickle cell anaemia (SCA) is an autosomal recessive disorder characterized by a point mutation in codon 6 of the beta globin chain, where glutamic acid is replaced by valine, resulting in the formation of HbS with varied clinical 1 manifestations . -
Sickle Cell Pathway V2.1: Suspected Acute Chest Syndrome Table of Contents
Sickle Cell Pathway v2.1: Suspected Acute Chest Syndrome Table of Contents Inclusion Criteria · New, non-atelactatic, pulmonary infiltrate in patient with a Stop and sickle cell hemoglobinopathy Review Exclusion Criteria · O2 need related to opiate use with no infiltrate on CXR Sickle Cell Care Suspected Acute Chest Syndrome Appendix Summary of Version Changes Approval & Citation Evidence Ratings For questions concerning this pathway, contact: Last Updated: October 2020 [email protected] Next Expected Review: October 2025 If you are a patient with questions contact your medical provider, Medical Disclaimer © 2020 Seattle Children’s Hospital, all rights reserved Sickle Cell Pathway v2.1: Suspected Acute Chest Syndrome Inclusion Criteria · New, non-atelactatic, pulmonary infiltrate in patient with a Stop and sickle cell hemoglobinopathy Review Exclusion Criteria · O2 need related to opiate use with no infiltrate on CXR Evaluations for Acute Chest · Physical Exam · CXR · O2 sats · Consider viral studies · Blood & Urine Cx · CBC, diff, retic and type and cross Admit if not already admitted Standard Conservative Therapy · Aggressive pain management · Incentive spirometry q 1 hrs while awake, 10 breaths every hour from 0800 to 2200 and with vital signs while awake from 2200 to 0800, as well as with every "as needed" IV bolus of pain medication, and prior to chest x-rays · Oxygen to maintain O2 saturation >93% · Ceftriaxone q 24 hours IV (Ciprofloxacin and Clindamycin if allergic to Ceftriaxone) ! · Azithromycin or other -
Nebulizers: Diagnosis Codes – Medicare Advantage Policy Appendix
UnitedHealthcare® Medicare Advantage Policy Appendix: Applicable Code List Nebulizers: Diagnosis Codes This list of codes applies to the Medicare Advantage Policy Guideline titled Approval Date: September 8, 2021 Nebulizers. Applicable Codes The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. The listing of a code does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and Guidelines may apply. Diagnosis Code Description For HCPCS Codes A7003, A7004, and E0570 A15.0 Tuberculosis of lung A22.1 Pulmonary anthrax A37.01 Whooping cough due to Bordetella pertussis with pneumonia A37.11 Whooping cough due to Bordetella parapertussis with pneumonia A37.81 Whooping cough due to other Bordetella species with pneumonia A37.91 Whooping cough, unspecified species with pneumonia A48.1 Legionnaires' disease B20 Human immunodeficiency virus [HIV] disease B25.0 Cytomegaloviral pneumonitis B44.0 Invasive pulmonary aspergillosis B59 Pneumocystosis B77.81 Ascariasis pneumonia E84.0 Cystic fibrosis with pulmonary manifestations J09.X1 Influenza due to identified novel influenza A virus with pneumonia J09.X2 Influenza due to identified novel influenza A virus with other -
Statistical Analysis Plan
Non-Interventional Study Protocol Study Code << DXXXRXXX >> Version V1.4 Date 14 July 2017 Decline In lung-function Among Patients with chronic obstructive Lung disease On maintenance therapy (DIAPLO) An observational study evaluating the benefits of early intervention with maintenance therapies to prevent or slow down rapid lung function decline in patients who are at high risk at the time of COPD diagnosis in the combined Optimum Patient Care Research Database and Clinical Practice Research Datalink databases TITLE PAGE Non-Interventional Study Protocol Study Code << DXXXRXXX >> Version 14 July 2017 Date 14 July 2017 TABLE OF CONTENTS PAGE TITLE PAGE ........................................................................................................... 1 TABLE OF CONTENTS ......................................................................................... 2 LIST OF ABBREVIATIONS .................................................................................. 5 RESPONSIBLE PARTIES ...................................................................................... 6 PROTOCOL SYNOPSIS DIAPLO STUDY ........................................................... 7 AMENDMENT HISTORY ................................................................................... 12 MILESTONES ....................................................................................................... 13 1. BACKGROUND AND RATIONALE .................................................................. 14 1.1 Background ........................................................................................................... -
Chapter 17 Dyspnea Sabina Braithwaite and Debra Perina
Chapter 17 Dyspnea Sabina Braithwaite and Debra Perina ■ PERSPECTIVE Pathophysiology Dyspnea is the term applied to the sensation of breathlessness The actual mechanisms responsible for dyspnea are unknown. and the patient’s reaction to that sensation. It is an uncomfort- Normal breathing is controlled both centrally by the respira- able awareness of breathing difficulties that in the extreme tory control center in the medulla oblongata, as well as periph- manifests as “air hunger.” Dyspnea is often ill defined by erally by chemoreceptors located near the carotid bodies, and patients, who may describe the feeling as shortness of breath, mechanoreceptors in the diaphragm and skeletal muscles.3 chest tightness, or difficulty breathing. Dyspnea results Any imbalance between these sites is perceived as dyspnea. from a variety of conditions, ranging from nonurgent to life- This imbalance generally results from ventilatory demand threatening. Neither the clinical severity nor the patient’s per- being greater than capacity.4 ception correlates well with the seriousness of underlying The perception and sensation of dyspnea are believed to pathology and may be affected by emotions, behavioral and occur by one or more of the following mechanisms: increased cultural influences, and external stimuli.1,2 work of breathing, such as the increased lung resistance or The following terms may be used in the assessment of the decreased compliance that occurs with asthma or chronic dyspneic patient: obstructive pulmonary disease (COPD), or increased respira- tory drive, such as results from severe hypoxemia, acidosis, or Tachypnea: A respiratory rate greater than normal. Normal rates centrally acting stimuli (toxins, central nervous system events). -
Medicare Approved Six Minute Walk Diagnosis Codes
MEDICARE APPROVED DIAGNOSIS CODES FOR SIX MINUTE WALK TESTING ICD-10 Codes that Support Medical Necessity Group 1 Codes: ICD-10 CODE DESCRIPTION B44.81 Allergic bronchopulmonary aspergillosis C33 Malignant neoplasm of trachea C34.00 Malignant neoplasm of unspecified main bronchus C34.01 Malignant neoplasm of right main bronchus C34.02 Malignant neoplasm of left main bronchus C34.10 Malignant neoplasm of upper lobe, unspecified bronchus or lung C34.11 Malignant neoplasm of upper lobe, right bronchus or lung C34.12 Malignant neoplasm of upper lobe, left bronchus or lung C34.2 Malignant neoplasm of middle lobe, bronchus or lung C34.30 Malignant neoplasm of lower lobe, unspecified bronchus or lung C34.31 Malignant neoplasm of lower lobe, right bronchus or lung C34.32 Malignant neoplasm of lower lobe, left bronchus or lung C34.80 Malignant neoplasm of overlapping sites of unspecified bronchus and lung C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung C34.91 Malignant neoplasm of unspecified part of right bronchus or lung C34.92 Malignant neoplasm of unspecified part of left bronchus or lung C78.00 Secondary malignant neoplasm of unspecified lung C78.01 Secondary malignant neoplasm of right lung C78.02 Secondary malignant neoplasm of left lung C78.30 Secondary malignant neoplasm of unspecified respiratory organ C78.39 Secondary malignant neoplasm of other respiratory organs -
Various Types of Pneumoconiosis
Pneumoconiosis MEANING Pneumoconiosis is a chronic lung disease caused due to the inhalation of various forms of dust particles, particularly in industrial workplaces, for an extended period of time. Hence it is also said to be an occupational lung disease, which are a particular subdivision of occupational related diseases that are related primarily to being exposed to harmful substances, whether they are gas or dusts, in the work place, and the pulmonary disorders that may result from it. The severity and type of pneumoconiosis depends on what the dust particles comprise of; for example, small amounts of certain substances, such as asbestos and silica, can lead to serious reactions, while others may not be as harmfulCoalworker's pneumoconiosis Various Types of Pneumoconiosis • The most common types of pneumoconiosis are: • coal workers’ pneumoconiosis, silicosis, • asbestosis. As is evident by their names, these pneumoconioses are caused due to the inhalation of coal mine dust, silica dust, and asbestos fibers. Usually, it takes several years for these pneumoconioses to develop and manifest themselves. However, sometimes, particularly with silicosis, it can develop quite rapidly, within a short period of being exposed to large amounts of silica dust. In their severe form, pneumoconioses often result in the impairment of the lungs, disability, and even untimely death. Asbestosis: This is caused due to the inhalation of fibrous minerals that asbestos is made of. The exposure begins with the baggers, who handle the asbestos by collecting them and packaging them, to workers that make products out of them such as insulation material, cement, and tiles, and people working in the shipbuilding industry, and construction workers. -
Plastic Bronchitis and the Role of Bronchoscopy in the Acute Chest Syndrome of Sickle Cell Disease*
bronchoscopy Plastic Bronchitis and the Role of Bronchoscopy in the Acute Chest Syndrome of Sickle Cell Disease* Chuanpit Moser, MD; Eliezer Nussbaum, MD, FCCP; and Dan M. Cooper, MD Study objectives: To review the prevalence, clinical features, and role of bronchoscopy in patients with plastic bronchitis during the acute chest syndrome (ACS) of sickle cell disease (SCD). Design: Eight-year review of clinical experience. Setting: Tertiary referral children’s hospital. Patients: Twenty-six pediatric inpatients with 29 ACS episodes requiring diagnostic bronchos- copy. Results: Of the pediatric inpatients with ACS who underwent bronchoscopy, plastic bronchitis was diagnosed in 21 of 29 episodes (72%). There was no difference in clinical features between the patients with and without plastic bronchitis. Bronchoscopy was an essential diagnostic tool, but its therapeutic benefits were doubtful. Conclusions: This is the first report of the prevalence of plastic bronchitis in patients with ACS of SCD. In our patient population, this condition was found to be common. The role of diagnostic bronchoscopy is essential. A large series, multicenter study is required to determine whether bronchoscopy and BAL are therapeutically beneficial when added to currently practiced supportive care. (CHEST 2001; 120:608–613) Key words: acute chest syndrome; bronchial cast; bronchoscopy; plastic bronchitis; pneumonia; sickle cell Abbreviations: ACS ϭ acute chest syndrome; SCD ϭ sickle cell disease he acute chest syndrome (ACS) of sickle cell SCD center, (2) compare clinical features of the T disease (SCD) is characterized by sudden-onset group with plastic bronchitis and the group without fever, cough, chest pain, and pulmonary opacity on plastic bronchitis, and (3) explore the role of bron- radiographic examination.