Adult respiratory distress syndrome caused by inhalation of oxides of nitrogen.

We experienced a case of permeability pulmonary edema (ARDS) caused by massive inhalation of oxides of nitrogen. Using a flow-directed pulmonary artery catheter (Swan-Ganz), we monitored the systemic and pulmonary circula-tion and searched for evidence of pulmonary microembolism by carrying out balloon-occluded pulmonary angiography (BOPA) at the bed-side. Then we observed coagulation, disorders, which may be found at a high rate of incidence in ARDS, and it is interesting to note that these disorders occurred during the same period as the appearance of microemboli in BOPA. We carried out peep respiratory management at 5-10cm H2O with a respirator. Massive administration of methylprednisolone, and heparin administration were carried out. The patient was disconnected from the respirator on the tenth day, and he was discharged about one month after injury.