Akute respiratorische Insuffizienz nach Inhalation von Betonstaub - eine Kasuistik

Abstract

Inhalation of inorganic, inert dusts, like concrete dust, has generally not been considered dangerous. Very rarely alterations following chronic exposures can be observed, such as airflow obstruction and increased mucous secretion. Acute reactions in terms of acute respiratory failure have not been described so far. The present case report introduces a 54-year old male patient who developed acute respiratory failure after sawing a concrete block for several hours without wearing a face mask. Save for a chronic obstructive pulmonary disease he was unremarkable for his past medical history. When the emergency physician arrived, oxyhaemoglobin saturation was only 54%. Severely obstructed breathing sounds and coarse bubbling rales over both lungs were audible. After endotracheal intubation, a great deal of white viscous mucus could be aspirated via the tubus. The chest radiograph after admission demonstrated cloudy, shadowed areas with emphasis on both lower lung fields. As pulmonary function did not improve inspite of drug therapy with prednisolone, theophylline, fenoterol, n-acetylcysteine and respiration therapy with 100% oxygen concentration, the patient was treated daily with bronchoscopic aspiration of the mucus. Only on the fourth day, after an additional ten hours in prone position, the lung function improved. The patient could be extubated on the fifth day. The final chest radiograph indicated no residuum apart from a very small shadowed area on the right angle between heart and diaphragm. The inhalation of dusts, which have long been considered inert, can cause acute pulmonary reactions. We suggest that the massive, mechanical covering on the alveolar layer with still alkaline concrete dust in conjunction with a history of chronic bronchitis was responsible for the acute inflammation and oedematous swelling of the bronchial mucosa, bronchospasm, secretion of a highly viscid mucus, atelectasis, and thus for the ARDS.