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Pediatric Acute Respiratory Distress Syndrome and Tracheal Injury in a Patient Requiring Extracorporeal Membrane Oxygenation Following Cement Aspiration: A Case Report

Overview
Journal Crit Care Explor
Specialty Critical Care
Date 2023 Aug 30
PMID 37644977
Authors
Madeleine Bohrer
Cai Long
Adrienne Thompson
Stasa Veroukis
Gurpreet Khaira
Affiliations
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Abstract

Background: Ingestion and aspiration of caustic substances is a common problem in pediatrics and carries the risk of associated aspiration pneumonitis, laryngeal injury, and esophageal injury. Extracorporeal membrane oxygenation (ECMO) has been used to support adults with acute respiratory distress syndrome (ARDS) from aspiration of cement dust, however, literature outlining pediatric management in cases of alkali lung and airway injuries is lacking.

Case Summary: A 6-year-old boy presented with ARDS from cement aspiration requiring high-pressure ventilation. He had further complications of tracheal injury with subsequent pneumomediastinum secondary to the alkali burn. He required ECMO to facilitate repeat bronchoscopy for cement particle washout and to enable recovery from ARDS and tracheal injury.

Conclusion: This case highlights the need to perform early bronchoscopy and gastrointestinal endoscopy for injury assessment and foreign body removal in alkali burns. It also emphasizes the value of ECMO support for respiratory failure and facilitating bronchoalveolar lavage when it is not otherwise tolerated.

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