Comprehensive Treatment In Acute Inhalation Of Yellow Phosphorus Poisoning Concurrent ALI/ARDS

Objective Acute lung injury and acute respiratory distress syndrome isa common clinical critically disease. Inhaled gas poisoning is one of theimportant reason which cause ALI/ARDS directly. Three ARDS caseswhich are caused by acute inhalation of yellow phosphorus will bediscussed in this paper,and also the possible mechanism and clinicalsignificance.Method Three patients inhale fire smoke, the main ingredient ofwhich is yellow phosphorus during the fire drill indoor. The symptomssuch as chest congestion, chest pain, dyspnea and so on appeared quicklyafter the inhalation. At the same time, chest CT suggests that their lung hasdifferent degrees of inflammatory damage. According to the AECC[1]defined ALI and ARDS:(1) acute and sudden onset of severe respiratorydistress;(2) bilateral infiltrates on frontal chest radiograph;(3) the absenceof left atrial hypertension(a pulmonary capillary wedge pressure <18mmHgor no clinical signs of left ventricular failure); and (4) severe hypoxemia(assessed by the PaO2/FiO2ratio);ALI exists when the PaO2/FiO2ratio is 300and>200mmHg regardless of the PEEP and FiO2, and ARDS when thePaO2/FiO2ratio is200mmHg again regardless of PEEP and FiO2. Thosethree patients were treated with a series of treatment which include lungprotective mechanical ventilation and low-dose of adrenal cortex hormones.At the same time, strict observation of the patient ’s oxygenation, vitalsigns and monitoring and follow-up chest X-ray and other relevantindicators organ function have been taken during the treatment.Results Two of the patients mentioned above condition improved inabout one week, prognosis of these two patients is favourable. The patientwith longest contact timewith yellow phosphorus in those three patients,condition recurrent, lead to ICU treatment lasted30days. And appearspontaneous pneumothorax, pulmonary fibrosis still remained when shedischarged.Conclusion Acute inhalation poisoning of yellow phosphorus, theprognosis of which has directly and close relationship with the timeinhalation of yellow phosphorus, serious case can cause spontaneouspneumothorax. Mechanical ventilation is an important means in treatARDS caused by acute inhalation poisoning of yellow phosphorus, and theventilation strategy is improving in recent year. Whether early andlow-dose use hormone can reduce the mortality of ARDS, and reduce theoccurrence of pulmonary fibrosis still need further study.