Extensive inhalation injury treated with veno-venous extracorporeal membrane oxygenation followed by systemic corticosteroid administration: A case report

Abstract

Thermal inhalation injuries have been consistently shown to increase mortality in patients with burns. However, there is no established management strategy for this type of injury. Here, we present a case of extensive airway burns followed by tracheobronchial stenosis, which was successfully treated with extracorporeal membrane oxygenation and systemic corticosteroid administration. A 60-year-old man with burns on 6% of his total body surface area (second degree) and extensive airway burns in the lower respiratory tract was transferred to the emergency department. On the fifth day of admission, veno-venous extracorporeal membrane oxygenation (ECMO) was performed to manage the refractory respiratory failure due to bronchial obstruction by significant bronchial membrane edema and formation of a pseudomembrane in the damaged bronchi. Lung-rest management using ECMO lasted for 8 days. Thereafter, progressive multiple tracheobronchial stenoses were observed. Steroid therapy based on the regimen for the management of bronchial chondritis effectively improved the bronchial structure. Finally, the patient was successfully weaned from mechanical respiratory support. Our case shows that ECMO may be a useful strategy in patients with extensive lower respiratory tract inhalation injuries who may experience difficulty in maintaining their respiratory status. In addition, corticosteroid therapy might be an adjunctive therapy to delay the tracheobronchial stenosis caused by progressive granulation tissue formation.

Keywords

• Inhalation injury
• Tracheobronchial stenosis
• Veno-venous extracorporeal membrane oxygenation
• Corticosteroid