Acute respiratory failure after aspiration of activated charcoal with recurrent deposition and release from an intrapulmonary cavern.
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.
Francis
Roland C E
RC
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
Schefold
Joerg C
JC
Bercker
Sven
S
Temmesfeld-Wollbrück
Bettina
B
Weichert
Wilko
W
Spies
Claudia D
CD
Weber-Carstens
Steffen
S
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
D002606:Charcoal
Eur J Pharmacol. 2006 Mar 8;533(1-3):15-27
16469310
Intensive Care Med. 2006 Sep;32(9):1423-7
16826384
Resuscitation. 2001 Jun;49(3):315-8
11723999
Lancet. 2008 Feb 16;371(9612):579-87
18280328
Thorax. 2008 Mar;63(3):215-20
17951278
J Toxicol Clin Toxicol. 2003;41(2):119-24
12733848
Proc Am Thorac Soc. 2006;3(1):41-7
16493150
Chest. 1989 Sep;96(3):672-4
2766830
Pulm Pharmacol Ther. 2006;19(2):96-100
15970448
Ann Pharmacother. 1994 Jul-Aug;28(7-8):915-24
7949514
Clin Lab Med. 2006 Mar;26(1):1-12, vii
16567222
Intensive Care Med. 2006 Jul;32(7):1060-5
16791669
J Toxicol Clin Toxicol. 1999;37(1):9-16
10078154
Ann Emerg Med. 1981 Oct;10(10):528-9
7283218
Intensive Care Med. 2006 May;32(5):740-9
16534568
Intensive Care Med. 2003 Dec;29(12):2303-2306
14647891