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Case Reports in Critical Care
Volume 2017, Article ID 7952782, 8 pages
https://doi.org/10.1155/2017/7952782
Case Report

Zinc Chloride Smoke Inhalation Induced Severe Acute Respiratory Distress Syndrome: First Survival in the United States with Extended Duration (Five Weeks) Therapy with High Dose Corticosteroids in Combination with Lung Protective Ventilation

1University of Nevada School of Medicine, Reno, NV, USA
2Renown Regional Medical Center, Reno, NV, USA
3U.S. Department of Veteran Affairs, Ioannis A. Lougaris Veteran Affairs Medical Center, Reno, NV, USA

Correspondence should be addressed to Hafiz Mahboob; ude.adaven.enicidem@boobhamh

Received 1 May 2017; Accepted 21 June 2017; Published 26 July 2017

Academic Editor: Kurt Lenz

Copyright © 2017 Hafiz Mahboob et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Zinc chloride smoke bomb exposure is frequently seen in military drills, combat exercises, metal industry works, and disaster simulations. Smoke exposure presents with variety of pulmonary damage based on the intensity of the exposure. Smoke induced severe acute respiratory distress syndrome (ARDS) is often fatal and there are no standard treatment guidelines. We report the first survival of smoke induced severe ARDS in the United States (US) with prolonged use of high dose steroids (five weeks) and lung protective ventilation alone. Previously reported surviving patients in China and Taiwan required extracorporeal membrane oxygenation (ECMO) and other invasive modalities. We suggest that an extended course of high dose corticosteroids should be considered for the treatment of smoke inhalation related ARDS and should be introduced as early as possible to minimize the morbidity and mortality. We further suggest that patients with smoke inhalation should be observed in the hospital for at least 48 to 72 hours before discharge, as ARDS can have a delayed onset. Being vigilant for infectious complications is important due to prolonged steroid treatment regimen. Patients must also be monitored for critical illness polyneuromyopathy. Additionally, upper airway injury should be suspected and early evaluation by otorhinolaryngology may be beneficial.