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Treatment of patients with different degree of acute respiratory distress syndrome caused by inhalation of white smoke.

Abstract Objective: To summarize the treatment experience of patients with different degree of acute respiratory distress syndrome (ARDS) caused by inhalation of white smoke from burning smoke bomb. Methods: A batch of 13 patients with different degree of ARDS caused by inhalation of white smoke from burning smoke bomb, including 2 patients complicated by pulmonary fibrosis at the late stage, were admitted to our unit in February 2016. Patients were divided into mild (9 cases), moderate (2 cases), and serious (2 cases) degree according to the ARDS Berlin diagnostic criteria. Patients with mild and moderate ARDS were conventionally treated with glucocorticoid. Patients with severe ARDS were sequentially treated with glucocorticoid and pirfenidone, and ventilator-assisted breathing, etc. were applied. The vital signs, arterial oxygenation index, changes of lung imaging, pulmonary ventilation function, general condition, and the other important organs/systems function were timely monitored according to the condition of patients. The above indexes were also monitored during the follow-up time of 10-15 months post injury. Data were processed with SPSS 18.0 statistical software. Results: (1) The symptoms of respiratory system of patients with mild and moderate ARDS almost disappeared after 3 days' treatment. Their arterial oxygenation index was decreased from post injury day 1 to 4, which almost recovered on post injury day 7 and completely recovered one month post injury. The symptoms of respiratory system of patients with severe ARDS almost disappeared at tranquillization condition 1-3 month (s) post injury. Their arterial oxygenation index was decreased from post injury day 3 to 21, which gradually recovered 1-3 month (s) post injury and was normal 15 months post injury. (2) Within 24 hours post injury, there was no obvious abnormality or only a little texture enlargement of lung in image of chest CT or X-rays of patients with mild and moderate ARDS. One patient with moderate ARDS had diffuse patchy and ground-glass like increased density shadow (pulmonary exudation for short) at post injury hour 96. Chest iconography of all patients with mild and moderate ARDS showed no abnormalities 10 months post injury. Both lungs of each of the two patients with severe ARDS showed obvious pulmonary exudation at post injury hours 45 and 75, respectively. One patient with severe ARDS showed no abnormality in chest image 10 months post injury, but there was still a small mesh-like increased density shadow in double lobes with slight adhesion of pleura in the other patient with severe ARDS 15 months post injury. (3) All patients showed severe restrictive hypoventilation when admitted to hospital. Pulmonary ventilation function of patients with mild and moderate ARDS recovered to normal one month post injury, and they could do exercises like running, etc. Pulmonary ventilation function of one patient with severe ARDS recovered to normal 6 months post injury, and the patient could do exercises like running, etc. The other patient with severe ARDS showed mild restrictive hypoventilation 15 months post injury and could do exercises like rapid walking, etc. (4) The condition of all mild and one moderate ARDS patients was better on post injury day 3, and they were transferred to the local hospital for subsequent treatment and left hospital on post injury day 21. One patient with moderate ARDS healed and left hospital on post injury day 29. Patients with severe ARDS healed and left hospital on post injury day 81. During the follow-up time of 10-15 months post injury, the other important organs/systems of all patients showed no abnormality, and there was no adverse reaction of glucocorticoid like osteoporosis, femoral head necrosis, or metabolic disorder. Two patients with severe ARDS did not have any adverse reaction of pirfenidone like liver function damage, photosensitivity, anorexia, or lethargy. Conclusions: Early enough and uninterrupted application of glucocorticoid can significantly reduce the ARDS of patients caused by inhalation of white smoke from burning smoke bomb. Sequential application of glucocorticoid and pirfenidone can effectively treat pulmonary fibrosis at the late stage.
PMID
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Authors

Mayor MeshTerms
Keywords

Glucocorticoids

Pirfenidone

Pulmonary fibrosis

Respiratory distress syndrome, adult

Smoke bomb

White smoke

Journal Title zhonghua shao shang za zhi = zhonghua shaoshang zazhi = chinese journal of burns
Publication Year Start




PMID- 29275617
OWN - NLM
STAT- In-Process
LR  - 20171225
IS  - 1009-2587 (Print)
IS  - 1009-2587 (Linking)
VI  - 33
IP  - 12
DP  - 2017 Dec 20
TI  - [Treatment of patients with different degree of acute respiratory distress
      syndrome caused by inhalation of white smoke].
PG  - 760-765
LID - 10.3760/cma.j.issn.1009-2587.2017.12.008 [doi]
AB  - Objective: To summarize the treatment experience of patients with different
      degree of acute respiratory distress syndrome (ARDS) caused by inhalation of
      white smoke from burning smoke bomb. Methods: A batch of 13 patients with
      different degree of ARDS caused by inhalation of white smoke from burning smoke
      bomb, including 2 patients complicated by pulmonary fibrosis at the late stage,
      were admitted to our unit in February 2016. Patients were divided into mild (9
      cases), moderate (2 cases), and serious (2 cases) degree according to the ARDS
      Berlin diagnostic criteria. Patients with mild and moderate ARDS were
      conventionally treated with glucocorticoid. Patients with severe ARDS were
      sequentially treated with glucocorticoid and pirfenidone, and ventilator-assisted
      breathing, etc. were applied. The vital signs, arterial oxygenation index,
      changes of lung imaging, pulmonary ventilation function, general condition, and
      the other important organs/systems function were timely monitored according to
      the condition of patients. The above indexes were also monitored during the
      follow-up time of 10-15 months post injury. Data were processed with SPSS 18.0
      statistical software. Results: (1) The symptoms of respiratory system of patients
      with mild and moderate ARDS almost disappeared after 3 days' treatment. Their
      arterial oxygenation index was decreased from post injury day 1 to 4, which
      almost recovered on post injury day 7 and completely recovered one month post
      injury. The symptoms of respiratory system of patients with severe ARDS almost
      disappeared at tranquillization condition 1-3 month (s) post injury. Their
      arterial oxygenation index was decreased from post injury day 3 to 21, which
      gradually recovered 1-3 month (s) post injury and was normal 15 months post
      injury. (2) Within 24 hours post injury, there was no obvious abnormality or only
      a little texture enlargement of lung in image of chest CT or X-rays of patients
      with mild and moderate ARDS. One patient with moderate ARDS had diffuse patchy
      and ground-glass like increased density shadow (pulmonary exudation for short) at
      post injury hour 96. Chest iconography of all patients with mild and moderate
      ARDS showed no abnormalities 10 months post injury. Both lungs of each of the two
      patients with severe ARDS showed obvious pulmonary exudation at post injury hours
      45 and 75, respectively. One patient with severe ARDS showed no abnormality in
      chest image 10 months post injury, but there was still a small mesh-like
      increased density shadow in double lobes with slight adhesion of pleura in the
      other patient with severe ARDS 15 months post injury. (3) All patients showed
      severe restrictive hypoventilation when admitted to hospital. Pulmonary
      ventilation function of patients with mild and moderate ARDS recovered to normal 
      one month post injury, and they could do exercises like running, etc. Pulmonary
      ventilation function of one patient with severe ARDS recovered to normal 6 months
      post injury, and the patient could do exercises like running, etc. The other
      patient with severe ARDS showed mild restrictive hypoventilation 15 months post
      injury and could do exercises like rapid walking, etc. (4) The condition of all
      mild and one moderate ARDS patients was better on post injury day 3, and they
      were transferred to the local hospital for subsequent treatment and left hospital
      on post injury day 21. One patient with moderate ARDS healed and left hospital on
      post injury day 29. Patients with severe ARDS healed and left hospital on post
      injury day 81. During the follow-up time of 10-15 months post injury, the other
      important organs/systems of all patients showed no abnormality, and there was no 
      adverse reaction of glucocorticoid like osteoporosis, femoral head necrosis, or
      metabolic disorder. Two patients with severe ARDS did not have any adverse
      reaction of pirfenidone like liver function damage, photosensitivity, anorexia,
      or lethargy. Conclusions: Early enough and uninterrupted application of
      glucocorticoid can significantly reduce the ARDS of patients caused by inhalation
      of white smoke from burning smoke bomb. Sequential application of glucocorticoid 
      and pirfenidone can effectively treat pulmonary fibrosis at the late stage.
FAU - Yang, F W
AU  - Yang FW
AD  - Department of Burns and Plastic Surgery, the 181st Hospital of PLA, Guilin
      541002, China.
FAU - Xin, H M
AU  - Xin HM
FAU - Zhu, J H
AU  - Zhu JH
FAU - Feng, X Y
AU  - Feng XY
FAU - Jiang, X C
AU  - Jiang XC
FAU - Gong, Z Y
AU  - Gong ZY
FAU - Tong, Y L
AU  - Tong YL
LA  - chi
PT  - English Abstract
PT  - Journal Article
PL  - China
TA  - Zhonghua Shao Shang Za Zhi
JT  - Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns
JID - 100959418
OTO - NOTNLM
OT  - Glucocorticoids
OT  - Pirfenidone
OT  - Pulmonary fibrosis
OT  - Respiratory distress syndrome, adult
OT  - Smoke bomb
OT  - White smoke
EDAT- 2017/12/26 06:00
MHDA- 2017/12/26 06:00
CRDT- 2017/12/26 06:00
PHST- 2017/12/26 06:00 [entrez]
PHST- 2017/12/26 06:00 [pubmed]
PHST- 2017/12/26 06:00 [medline]
PST - ppublish
SO  - Zhonghua Shao Shang Za Zhi. 2017 Dec 20;33(12):760-765.