Francis Roland C E, Schefold Joerg C, Bercker Sven, Temmesfeld-Wollbrück Bettina, Weichert Wilko, Spies Claudia D, Weber-Carstens Steffen
Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Intensive Care Med. 2009 Feb;35(2):360-3. doi: 10.1007/s00134-008-1259-5. Epub 2008 Sep 16.
To report on the recurrent release of charcoal from an intrapulmonary cavern in a case of acute respiratory failure after charcoal aspiration.
Case report.
Anaesthesiological ICU, university hospital.
An 18-year-old ethanol intoxicated comatose patient regurgitated and aspirated activated charcoal during orotracheal intubation.
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.
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.
报告一例吸入活性炭后发生急性呼吸衰竭的患者，其肺内空洞反复排出活性炭的情况。
病例报告。
大学医院麻醉重症监护病房。
一名18岁乙醇中毒昏迷患者在经口气管插管期间发生反流并吸入了活性炭。
机械通气2天后，患者被转至一家三级大学医院。入院时，诊断为伴有双侧肺部浸润的急性呼吸窘迫综合征。患者的康复因肺内空洞反复排出活性炭而受阻。复杂的通气支持、俯卧位通气、黏液溶解剂、反复支气管镜检查和抗生素治疗可能促进了支气管肺泡清除，并在18天后实现了脱机。
如果在没有气道保护的昏迷患者中使用活性炭，吸入可能是一种严重的并发症。在本病例报告中，需要采取先进的重症监护措施来应对肺内空洞排出活性炭这一特殊情况。
