title: Acute respiratory failure after aspiration of activated charcoal with recurrent deposition and release from an intrapulmonary cavern.
abstract: OBJECTIVE
  To report on the recurrent release of charcoal from an intrapulmonary cavern in a case of acute respiratory failure after charcoal aspiration.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Anaesthesiological ICU, university hospital.
  
  
  METHODS
  An 18-year-old ethanol intoxicated comatose patient regurgitated and aspirated activated charcoal during orotracheal intubation.
  
  
  METHODS
  After 2 days of mechanical ventilation, the patient was transferred to a tertiary care university hospital. On admission, acute respiratory distress syndrome with bilateral pulmonary infiltrations was diagnosed. The patient's recovery was hampered by recurrent release of charcoal from an intrapulmonary cavern. Sophisticated ventilatory support, prone positioning, secretolytics, repetitive bronchoscopy, and antibiotic therapy may have facilitated bronchoalveolar clearance and weaning after 18 days.
  
  
  CONCLUSIONS
  Aspiration may be a dramatic complication if charcoal is administered in comatose patients without airway protection. In this case report, advanced intensive care measures were necessary to tackle the special feature of charcoal release from an intrapulmonary cavern.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. roland.francis@charite.de
authors.forename: Roland C E
authors.initials: RC
authors.lastname: Francis
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Schefold
authors.forename: Sven
authors.initials: S
authors.lastname: Bercker
authors.forename: Bettina
authors.initials: B
authors.lastname: Temmesfeld-Wollbrück
authors.forename: Wilko
authors.initials: W
authors.lastname: Weichert
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
authors.forename: Steffen
authors.initials: S
authors.lastname: Weber-Carstens
mesh_terms: D000293:Adolescent; D001706:Biopsy; D001999:Bronchoscopy; D002606:Charcoal / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008168:Lung / Q000378:metabolism* / Q000473:pathology*; D008297:Male; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014139:Tracheostomy
chemical_list: D002606:Charcoal
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