Two cases of powder aspiration are reported. A 7 1/2-month-old girl showed a classical course with an asymptomatic period of 3-4 hours, then severe respiratory distress developed. Acute respiratory insufficiency made tracheal intubation and mechanical ventilation necessary for 10 days. Complications included insufficient alveolar ventilation, atelectasis, pneumothorax, and superinfection. But the baby recovered with some residual radiological changes in the lungs. A 13-month-old boy was treated immediately after massive powder aspiration by tracheal intubation and bronchial wash-out. The postoperative course was unevetful and no respiratory distress developed. Powder aspiration leads to severe bronchiolar obstruction with a delay of several hours and has a high mortality rate. The best results in treatment are obtained by immediate intubation and bronchial wash-out, even in the absence of respiratory symptoms. Artifical ventilation may be necessary with the special problem of overcoming very high airway resistance. Corticosteroids and bronchodilators may be helpful.
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