Acute respiratory distress syndrome after zinc chloride inhalation: survival after extracorporeal life support and corticosteroid treatment.
No standard protocol exists for the treatment of acute respiratory distress syndrome induced by inhalation of smoke from a smoke bomb. In this case, a 23-year-old man was exposed to smoke from a smoke grenade for approximately 10 to 15 minutes without protective breathing apparatus. Acute respiratory distress syndrome developed subsequently, complicated by bilateral pneumothorax and pneumomediastinum 48 hours after inhalation. Despite mechanical ventilation and bilateral tube thoracostomy, the patient was severely hypoxemic 4 days after hospitalization. His condition improved upon treatment with high-dose corticosteroids, an additional 500-mg dose of methylprednisolone, and the initiation of extracorporeal life support. Arterial oxygenation decreased gradually after abrupt tapering of the corticosteroid dose and discontinuation of the life support. On day 16 of hospitalization, the patient experienced progressive deterioration of arterial oxygenation despite the intensive treatment. The initial treatment regimen (ie, corticosteroids and extracorporeal life support) was resumed, and the patient's arterial oxygenation improved. The patient survived.
Chian
Chih-Feng
CF
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Wu
Chin-Pyng
CP
Chen
Chien-Wen
CW
Su
Wen-Lin
WL
Yeh
Chin-Bin
CB
Perng
Wann-Cherng
WC
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002712:Chlorides / Q000506:poisoning*; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000628:therapy*; D015208:Smoke Inhalation Injury / Q000139:chemically induced* / Q000628:therapy*; D013907:Thoracostomy; D055815:Young Adult; D017967:Zinc Compounds / Q000506:poisoning*
D000900:Anti-Bacterial Agents; D002712:Chlorides; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents; D017967:Zinc Compounds; C016837:zinc chloride