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American Journal of Critical Care. 2010;19: 86-90 doi:10.4037/ajcc2009908
Copyright © 2010 by the American Association of Critical-Care Nurses.
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Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient’s experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc{at}aacn.org.

Acute Respiratory Distress Syndrome After Zinc Chloride Inhalation: Survival After Extracorporeal Life Support and Corticosteroid Treatment

By Chih-Feng Chian, MD, Chin-Pyng Wu, MD, PhD, Chien-Wen Chen, MD, Wen-Lin Su, MD, MPH, Chin-Bin Yeh, MD and Wann-Cherng Perng, MD. Chih-Feng Chian, Chin-Pyng Wu, Chien-Wen Chen, Wen-Lin Su, and Wann-Cherng Perngare all physicians in the Division of Pulmonary Medicine, Department of Internal Medicine, and Chin-Bin Yeh is a physician in the Department of Psychiatry at Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Corresponding author: Wann-Cherng Perng, MD, Division of Pulmonary Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Rd, Taipei, Taiwan, Republic of China (e-mail: chest{at}mail.ndmctsgh.edu.tw).

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.






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Copyright © 2010 by the American Association of Critical-Care Nurses.