Review of clinical experience in handling phosgene exposure cases

In summary, we have described our method of treating phosgene inhalation injury. We have presented two serious cases in detail which demonstrate that survival was associated with aggressive therapy. Several points should be mentioned. The pulmonary edema and resulting fluid and foam production can be so copious as to overwhelm efforts to place an endotracheal tube. The solution is early intubation by the nearest experienced person at the first hint of edema or pulmonary failure. Adequate support of the patient's blood volume is imperative to avert hypovolemic shock and renal failure. A balloon flotation catheter is desirable to monitor pulmonary wedge pressure and avoid overload. Follow-up pulmonary function studies and chest x-rays are recommended 2-3 months after hospital discharge. We have not yet found a reliable test to determine which cases will progress to pulmonary edema. The LDH appears to be the only consistently elevated sign in more serious cases. Finally, we would like to make a plea for the sharing of information from instances of fatal phosgene injury so that the facts can be studied and applied to future cases.