Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Am J Crit Care. 2010 Jan;19(1):86-90. doi: 10.4037/ajcc2009908. Epub 2009 Mar 19.
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.
目前尚无吸入烟雾弹烟雾导致急性呼吸窘迫综合征的标准治疗方案。本例中，1 名 23 岁男性在没有防护呼吸设备的情况下暴露于烟雾弹烟雾中约 10-15 分钟，随后发生急性呼吸窘迫综合征，48 小时后并发双侧气胸和纵隔气肿。尽管给予机械通气和双侧胸腔引流，但患者在住院 4 天后仍严重低氧血症。在给予大剂量皮质类固醇、甲泼尼龙 500mg 冲击治疗以及开始体外生命支持后，病情有所改善。皮质类固醇剂量突然减少和停止生命支持后，动脉血氧饱和度逐渐下降。住院第 16 天，尽管给予强化治疗，患者的动脉血氧饱和度仍逐渐恶化。重新开始初始治疗方案（即皮质类固醇和体外生命支持）后，患者的动脉血氧饱和度改善，最终存活。
