[A study of the clinical features and the effect of therapy on acute respiratory distress syndrome patients as a result of severe triphosgene poisoning].
OBJECTIVE
To investigate the clinical features and treatment strategy for acute respiratory distress syndrome (ARDS) caused by phosgene.


METHODS
Individualized therapy was carried out in 17 cases of severe phosgene poison patients. Blood routine, electrolytes, blood gas analysis, hepatic and renal function tests and cardiac enzymes were examined before and after treatment.


RESULTS
Vital signs, fluid, electrolytes and acid-base disturbances were improved after treatment. As compared to that of pre-treatment period, white blood cells [WBC, ×10(9)/L: 12.18 ± 4.76 vs. 21.93 ± 6.21], neutrophil percentage (0.87 ± 0.05 vs. 0.92 ± 0.03), hemoglobin (Hb, g/L: 128.12 ± 25.65 vs. 173.71 ± 23.53), blood platelet count [PLT,×10(9)/L:165.12 ± 31.70 vs. 254.47 ± 70.80], alanine transaminase (ALT, U/L: 70.71 ± 46.70 vs. 212.71 ± 141.34), aspartate aminotransferase (AST, U/L: 52.47 ± 34.68 vs. 82.41 ± 34.60), blood urea nitrogen (BUN, mmol/L: 5.83 ± 4.09 vs. 7.89 ± 5.96), serum creatinine (SCr,  μmol/L: 48.13 ± 14.97 vs. 67.25 ± 24.29), lactate dehydrogenase (LDH, U/L: 280.10 ± 81.77 vs. 586.35 ± 186.71), creatine kinase (CK, U/L: 199.12 ± 106.75 vs. 683.00 ± 323.21), MB isoenzyme of creatine kinase (CK-MB, U/L: 26.94 ± 9.13 vs. 45.59 ± 11.21), serum chlorine anion [Cl(-), mmol/L: 95.88 ± 6.06 vs. 102.29 ± 7.28], respiratory  rate  (RR,  beats/min:  20.88 ± 4.30   vs.  30.06 ± 5.78),  heart  rate  (HR,  beats/min:  82.76 ± 17.16  vs. 113.35 ± 16.90), blood pH value (7.34 ± 0.44  vs.  7.39 ± 0.03)  were  all  decreased (P < 0.05 or  P < 0.01). Serum sodium ion [Na(+),mmol/L:140.61 ± 6.69 vs. 134.06 ± 4.80], arterial partial pressure of   oxygen  [PO(2), mm Hg, 1 mm Hg = 0.133 kPa: 84.41 ± 30.58 vs. 59.88 ± 15.19] and pulse oxygen saturation [SpO(2): 0.91 ± 0.08 vs. 0.78 ± 0.15] were increased (P < 0.05 or P < 0.01). Sixteen patients totally recovered, 1 patient died, and the cure rate was 94.12%.


CONCLUSIONS
Respiratory system could be mainly injured as the result of exposure to phosgene and leading to ARDS. Early initial combination therapies with corticosteroids and respiratory support should be addressed.
Intensive Care Unit, Anhui Provincial Hospital, Hefei 230001, Anhui, China.
Lin-lin
LL
Zhang
Shu-sheng
SS
Zhou
Bao
B
Liu
Zi-min
ZM
Sun
Tian-jun
TJ
Yang
Shou-jun
SJ
Zhu
Hua
H
Fan
D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D010705:Phosgene / Q000506:poisoning*; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult
D010705:Phosgene