Tiki Torch Fuel Injury in a Toddler Requiring Extracorporeal Life Support

ABSTRACT

INTRODUCTION: Injury from hydrocarbon inhalation, such as with tiki torch fuel, can range from asymptomatic requiring only observation to fatal due to severe acute respiratory distress syndrome. Treatment is largely supportive. DESCRIPTION A 12-month-old male was found by a family member drenched in tiki torch fluid with suspected hydrocarbon inhalation. On presentation to the Emergency Department, he was lethargic but with a clear respiratory exam. Within an hour, he developed tachypnea and hypoxemia requiring endotracheal intubation. Chest radiography revealed interval increase in bilateral heterogeneous airspace opacities. He was also found to be parainfluenza 3 positive. Despite optimization of sedation and paralysis, administration of corticosteroids and bronchodilators, and increasing respiratory support, he had worsening hypoxemia and hypercarbia. On hospital day 2, he had an oxygenation index of 60 and a P/F ratio of 40, so he underwent cannulation with veno-arterial extracorporeal membrane oxygenation (ECMO). In addition to diuretics and chest physiotherapy, due to persistent fevers, elevated inflammatory markers, and severity of illness, he received antibiotics for 7 days. Over the next 3 days, he improved and was subsequently decannulated from ECMO. Sixteen days after initial injury, he was extubated and weaned from supplemental oxygen three days later. He has not had any respiratory complications in the 12 months since injury. However, he did require rehospitalization due to thrombotic stroke suspected to be secondary to recent COVID-19 infection, history of ECMO and family history of thromboembolic events. DISCUSSION: Although most children with injuries related to hydrocarbon ingestion and aspirations can be observed and discharged, some injuries can lead to significantly worse symptoms including pulmonary edema, bronchoconstriction, hypoxemia and worsening respiratory distress which may require invasive support or ultimately be fatal. Presentations can evolve rapidly over 6-8 hours and peak at 48 hours due to the disturbance of surfactant and consequences of inflammation. While bronchodilators may provide benefit, steroids and surfactant therapy is controversial. Therapy is largely supportive. Most children can be expected to have a full recovery.