Chlorine inhalation-induced ARDS treated with noninvasive ventilation and awake prone positioning: a case report

Chlorine-containing disinfectants are widely used as household cleaning agents and in swimming pools and industrial settings. Accidents involving these disinfectants are an important public health concern. Exposure to high chlorine concentrations can induce acute chlorine toxicity, with acute poisoning from chlorine gas primarily affecting the respiratory system and causing irritation of the eyes, nose, and throat, and occasionally the skin. Significant exposure may result in acute respiratory distress syndrome (ARDS), which carries a risk of mortality. This report describes the case of a 76-year-old man who developed chlorine inhalation-induced ARDS after exposure to toxic gas generated from a trichloroisocyanuric acid disinfectant in a swimming pool. On admission, his PaO₂/FiO₂ ratio was 184 mmHg, meeting the Berlin definition of ARDS. He presented with progressive dyspnea and bilateral pulmonary infiltrates, and recovered completely after treatment using noninvasive mechanical ventilation, awake prone positioning, glucocorticoids, and comprehensive supportive treatment. As there is no specific antidote for chlorine poisoning, management focuses on symptomatic treatment, prevention of complications, and close observation until the patient is clinically stable. This case shows that early recognition and comprehensive supportive treatment, including noninvasive ventilation and awake prone positioning, can improve oxygenation, prevent intubation, and achieve favorable clinical outcomes.