Capillary leak syndrome: A rare cause of acute respiratory distress syndrome

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.