Successful extracorporeal life support after potentially fatal pulmonary oedema caused by inhalation of nitric and hydrofluoric acid fumes

• Published in: Resuscitation Vol. 75; no. 1; pp. 184 - 188
• Main Authors: Shin, Jae Seung, Lee, Sung-Woo, Kim, Nak-Hoon, Park, Jon-Su, Kim, Kwang Ja, Choi, Sung-Hyuk, Hong, Yun-Sik
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.10.2007; Elsevier
• Subjects: Adult; Air Pollutants, Occupational - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Calcium gluconate; Electroplating; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Explosive Agents - administration & dosage; Explosive Agents - adverse effects; Extracorporeal life support; Extracorporeal Membrane Oxygenation - methods; Fatal Outcome; Humans; Hydrofluoric acid; Hydrofluoric Acid - administration & dosage; Hydrofluoric Acid - adverse effects; Intensive care medicine; Male; Medical sciences; N-Acetylcysteine; Nitric acid; Nitric Acid - administration & dosage; Nitric Acid - adverse effects; Occupational Exposure - adverse effects; Pneumology; Pulmonary Edema - chemically induced; Pulmonary Edema - therapy; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Pulmonary oedema; Calcium gluconate; N-Acetylcysteine; Pulmonary oedema; Nitric acid; Extracorporeal life support; Hydrofluoric acid; Thiol; Intensive care; Calcium; Acetylcysteine; Inorganic element; Inhalation; Mucolytic; Fumes; Resuscitation
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2007.04.004

Summary Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5 h after inhalation. The other patient also rapidly progressed to respiratory failure. Extracorporeal life support (ECLS) was started 5 h after exposure at the ED. During ECLS, hypoxia improved, but pulmonary oedema shown by chest radiography became aggravated. N -Acetyl cysteine and calcium gluconate were given i.v. on the first day of admission and nebulised for 48 h after exposure. Pulmonary secretions were significantly reduced 24 h after the nebulising therapy began. Ultimately, the patient was discharged without serious pulmonary or neurological complications after 28 days of hospitalisation. In this case, early ECLS, nebulised antioxidant and antidote were available to treat potentially fatal pulmonary oedema after exposure to nitric and hydrofluoric acid fumes.