Bur A, Wagner A, Röggla M, Berzlanovic A, Herkner H, Sterz F, Laggner A N
Department of Emergency Medicine, Vienna General Hospital, University Clinics, Austria.
Resuscitation. 1997 Aug;35(1):33-6. doi: 10.1016/s0300-9572(97)00029-4.
We report a case of acute inhalation injury of nitric acid in a 56-year old white male. The patient presented conscious and dyspnoic at the emergency department after cleaning a copper chandelier with nitric acid. He had to be intubated 2 h after admission and mechanically ventilated because of fulminant respiratory insufficiency. As all sources of mechanical ventilation failed, extracorporeal membrane oxygenation had to be established 7 h after admission. With the additional use of surfactant and low dose inhalation therapy with nitric oxide (NO), the patient could be stabilised for 3 days and lung function improved temporarily. Despite all efforts the patient died at the fourth day from refactory respiratory failure. Pathologic examination revealed massive pulmonary edema without signs of inflammation. Thus, nitric acid inhalation induced pulmonary edema appears to be a most severe situation in which even most modern therapeutic interventions fail. As, in respect of recent literature and our case no promising therapy for nitric acid inhalation pulmonary edema is available, our efforts have to be directed towards prevention of nitric acid exposure.
我们报告一例56岁白人男性的急性硝酸吸入性损伤病例。该患者在用硝酸清洁铜吊灯后，在急诊科表现为神志清醒但呼吸困难。入院2小时后，因暴发性呼吸功能不全，他不得不接受气管插管并进行机械通气。由于所有机械通气方式均失败，入院7小时后不得不建立体外膜肺氧合。通过额外使用表面活性剂和低剂量一氧化氮（NO）吸入疗法，患者病情稳定了3天，肺功能暂时改善。尽管竭尽全力，患者在第四天死于难治性呼吸衰竭。病理检查显示有大量肺水肿，但无炎症迹象。因此，硝酸吸入所致肺水肿似乎是一种极其严重的情况，即使是最现代的治疗干预措施也会失败。鉴于近期文献及我们的病例显示，对于硝酸吸入性肺水肿尚无有效的治疗方法，我们必须致力于预防硝酸暴露。
