Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2022; 10(13): 4324-4326
Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4324
Capillary leak syndrome: A rare cause of acute respiratory distress syndrome
Deven Juneja, Sahil Kataria
Deven Juneja, Sahil Kataria, Department ofCritical Care Medicine, Max Super Speciality Hospital, Delhi 110017, India
Author contributions: Juneja D and Kataria S contributed equally to this work; Juneja D performed the literature search, and designed and edited the manuscript; Kataria S wrote and revised the manuscript; all the authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, DNB, MBBS, Director, Department of Critical Care Medicine, Max Super Speciality Hospital, 1 Press Enclave Road, Saket, Delhi 110017, India. devenjuneja@gmail.com
Received: November 30, 2021
Peer-review started: November 30, 2021
First decision: December 27, 2021
Revised: January 5, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: May 6, 2022
Processing time: 150 Days and 22.4 Hours
Abstract

Capillary leak syndrome (CLS) is a rare clinical syndrome associated with significant morbidity and mortality. Intensive care and supportive therapy constitute the mainstay of the treatment, along with judicious use of crystalloids and colloids such as dextran and starch during the leak phase. The advantages of proning, steroids, and intravenous immunoglobins are worth contemplating in patients with such a presentation. Extracorporeal membrane oxygenation appears to be an excellent strategy to surmount the impediments of the leak and post leak phase of CLS, especially in patients with severe or refractory hypoxemia.

Keywords: Extracorporeal membrane oxygenation; Capillary leak syndrome; Organophosphorus poisoning; Hemodynamics

Core Tip: Despite various studies on capillary leak syndrome (CLS) management, there is no consensus on its specific treatment measures. Intensive care with judicious fluid use is the mainstay of therapy. The outcome of patients with acute respiratory distress syndrome and refractory hypoxemia may be improved with proning and extracorporeal membrane oxygenation support. Steroid and intravenous immunoglobulin (IVIG) therapy may be helpful in the management of severe CLS. However, there is a clear need for clinical trials to determine the therapeutic efficacy of steroids, IVIGs, and other agents targeting the various pathophysiologic mechanisms for severe CLS. Determining the optimal dosage and duration of therapy will facilitate the establishment of treatment guidelines.