Bronchoscopic lung lavage and exogenous surfactant successfully reverse respiratory failure after severe chlorine exposure: A pediatric case report.

KEY CLINICAL MESSAGE: Although the symptoms of accidental chlorine inhalation are typically mild, severe exposure can result in acute respiratory distress syndrome (ARDS). We present a case of pediatric ARDS due to chlorine exposure in which lung lavage and exogenous surfactant were successful in avoiding more invasive and costly treatments.

ABSTRACT: Chlorine inhalation as a result of swimming pool chlorination accidents is relatively common. Because symptoms are typically mild (cough and bronchospasm), complications such as severe acute respiratory distress syndrome (ARDS) are identified at a late stage, which places the patient's life at risk and necessitates highly invasive interventions. We present a case of severe ARDS in a 14-year-old boy following accidental exposure to chlorine powder. Upon arrival in the pediatric emergency department, the patient received oxygen administration, nebulized salbutamol, and intravenous steroids because of dyspnea and cyanosis. Despite this treatment, the patient's respiratory condition deteriorated. Early intubation and lung-protective ventilation transitorily improved hypoxemia. Given the underlying pathophysiology of chlorine lung injury characterized by surfactant dysfunction, the boy was treated with repeated bronchoscopic lung lavages followed by exogenous surfactant (Curosurf 30 mg/kg total), 1 h after intubation and subsequently after 6 and 12 h, when he achieved a significant and stable reduction in ventilatory requirements. This case study illustrates the beneficial effects of target therapy with bronchoscopic lung lavage followed by exogenous surfactant in chlorine related ARDS to prevent more invasive and costly treatments.