Survival of severe ARDS with five-organ system failure following burns and inhalation injury in a 15-year-old patient.
OBJECTIVE
To show the effectiveness of an integrated therapeutical approach in a severe case of acute respiratory distress syndrome (ARDS) following burns, inhalation injury with therapy-refractory oxygenation under maximized ventilatory settings, and an overall complicated clinical course.


METHODS
Case report of a patient with severe inhalation injury and burns in an intensive care unit setting, undergoing cardiopulmonary resuscitation (CPR), nitric oxide (NO)-inhalation, surfactant-, kinetic-, and urodilatin-therapy.


METHODS
A 15-year-old male presented with deep dermal and full thickness thermal injuries involving 25% of his total body surface area. Shortly after presentation, the patient developed therapy-refractory respiratory failure, cardiac arrest, and subsequently suffered five-organ system failure (lung, heart, gastrointestinal, liver, kidney), in addition to burn injury, and ischemia related cerebral lesions. The patient was successfully treated with cardiac resuscitation, extra corporeal membrane oxygenation (ECMO), NO, kinetic therapy, surfactant, urodilatin, and other standard intensive care regimens. Three months post-trauma the patient was discharged home, nearly fully recovered.


CONCLUSIONS
In a patient with severe ARDS, oxygenation failure under maximized ventilatory settings, and subsequent five-organ system failure, an integrated therapeutical approach comprising ECMO, NO, kinetic therapy, surfactant, and urodilatin did cross-bridge respiratory and vital functions, enabling overall survival.
Cedidi
Can
C
Clinic for Plastic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Krankenhaus Oststadt, Podbielskistrasse 380, 30659 Hannover, Germany. cedidi@kliniklum-wuppertal.de
Hierner
Robert
R
Pichlmaier
Maximilian
M
Forssmann
Wolf Georg
WG
Meyer
Markus
M
D000293:Adolescent; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002056:Burns / Q000150:complications*; D002059:Burns, Inhalation / Q000150:complications / Q000628:therapy; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000150:complications / Q000628:therapy*; D009569:Nitric Oxide / Q000008:administration & dosage; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012399:Rotation; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D009569:Nitric Oxide