title: [Vegetable oil-induced acute respiratory distress syndrome (ARDS) in near drowning: evaluation based on extravascular lung water index].
abstract: Lipoid pneumonia usually presents after chronic recurrent ingestion of oily substances or accidental aspiration during "fire-eating" demonstrations. Massive exposure by near drowning extremely rare and potentially fatal. We present here a case of survival after total immersion in oil in her workplace. A 66-year-old woman who nearly drowned in a vat of vegetable oil was admitted as an emergency case with severe hypoxia after rescue. Chest computed tomography (CT) findings showed bilateral ground-glass opacity, consolidation, and the case fulfilled the criteria for acute respiratory distress syndrome (ARDS). Bronchoscopy and bronchoalveolar lavage performed on admission indicated oil droplets and marked neutrophilia (67%), which made us diagnose ARDS induced by lipoid pneumonia. We commenced treatment with pulsed steroids and strictly managed fluid balance under mechanical ventilation. Despite immediate improvement in oxygenation, the value of extravascular lung water index (EVLWI) measured by the PiCCO system consistently remained over 30 ml/Kg through her clinical course. We concluded that lipoid pneumonia is characterized by prolonged elevatation of pulmonary vascular permeability.
authors.affiliation: Emergency and Critical Care Medical Center, Osaka City General Hospital.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Rinka
authors.forename: Arito
authors.initials: A
authors.lastname: Kaji
mesh_terms: D000368:Aged; D002199:Capillary Permeability; D015633:Extravascular Lung Water; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008168:Lung / Q000098:blood supply; D015701:Near Drowning / Q000150:complications*; D010938:Plant Oils / Q000009:adverse effects* / Q000493:pharmacokinetics; D011017:Pneumonia, Lipid / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014764:Viral Proteins
chemical_list: C505906:BALF1 protein, Epstein-Barr virus; D010938:Plant Oils; D014764:Viral Proteins