Department of Pediatrics, Wayne State University, Detroit, Michigan, MI, USA.
Pediatrics. 2011 Jun;127(6):e1600-4. doi: 10.1542/peds.2010-3229. Epub 2011 May 29.
Hydrocarbon ingestions account for a substantial number of accidental poisonings; when aspirated, it can lead to severe pneumonitis. Treatment for severe pneumonitis is generally supportive, and outcomes are frequently poor. We report here the case of a 19-month-old girl who was treated successfully with early administration of exogenous surfactant for acute respiratory distress syndrome secondary to aspiration of lamp oil. Approximately 7 hours after aspiration, she required mechanical ventilation and had an oxygenation index (OI) of 13.2. Approximately 10 hours after ingestion, exogenous surfactant (calfactant) was instilled intratracheally, after which her OI improved markedly to 4.3. She received a second dose ∼19 hours after ingestion, after which her OI remained at <5 and she was progressively weaned from mechanical ventilation. She was extubated 64 hours after the ingestion with no residual lung disease. This case illustrates the importance of considering exogenous surfactant therapy early in the course of acute respiratory failure secondary to hydrocarbon aspiration. Because of the putative mechanisms of lung injury involved in hydrocarbon aspiration, surfactant-replacement therapy is a reasonable therapeutic intervention based on pathophysiologic rationale.
烃类摄入是大量意外中毒的原因；如果被吸入，可能会导致严重的肺炎。严重肺炎的治疗通常是支持性的，结果往往很差。我们在此报告一例 19 个月大的女孩，她因吸入灯油导致急性呼吸窘迫综合征，早期给予外源性表面活性剂治疗成功。吸入后约 7 小时，她需要机械通气，氧合指数（OI）为 13.2。吸入后约 10 小时，经气管内滴入外源性表面活性剂（calfactant），OI 显著改善至 4.3。摄入后约 19 小时给予第二剂，OI 仍低于 5，逐渐脱离机械通气。摄入后 64 小时拔管，无残留肺部疾病。本例说明在烃类吸入引起的急性呼吸衰竭早期考虑外源性表面活性剂治疗的重要性。由于烃类吸入涉及潜在的肺损伤机制，基于病理生理学原理，表面活性剂替代治疗是一种合理的治疗干预措施。
