Improvement of Acute Respiratory Distress Syndrome with Ethyl Alcohol Infusion into the Airway: A Case Report

Background:This case involves a male in his late thirties who was transported from another institution to our hospital in a state of haemorrhagic shock after receiving severe injuries in a traffic accident. Case Presentation: After hospitalisation and artificial respiration under sedation, his respiratory condition worsened on the 2nd hospital day, and he was diagnosed with acute respiratory distress syndrome (ARDS) with an arterial oxygen partial pressure to fractional inspired oxygen [PaO2/FiO2 (P/F)] ratio of ≤ 300. A large amount of bloody foamy sputum was expectorated on the 4th hospital day, and his P/F ratio decreased to 44; the amount of sputum did not reduce even after implementing sputum suction every 3-5 min. We considered introducing an extracorporeal membrane oxygenation device, but because it was an emergency situation with <80% of percutaneous oxygen saturation, we instead performed suction operation several times immediately after injecting 10 cc of ethyl alcohol (76.9 to 81.6 vol%) into the pulmonary alveoli. Subsequently, bloody foamy sputum expectoration was suddenly decreased, and the patient recovered from ARDS on the 7th hospital day, with a marked improvement in his P/F ratio. Conclusions: We have reported the implications of our continuous measurement for neutrophil elastase, interleukin 8 and surfactant protein D in blood and sputum, as well as how these metrics related to the patient’s respiratory state.