Efficacy of Early Noninvasive Ventilation in Three Cases of Nonfatal Drowning with Pulmonary Oedema in the Paediatric Emergency Department

Abstract

Drowning is still one of the most important causes of the preventable mortality worldwide. Some patients should be treated with noninvasive ventilation immediately in the emergency department (ED). The practice of noninvasive ventilation has been increased recently in the paediatric ED. We present here three nonfatal drowning patients with pulmonary oedema and hypoxia who were successfully treated with noninvasive ventilation in the paediatric emergency department. All of the patients had aspirated sea water during swimming. In addition, two of the patients had aspirated water during snorkeling. Noninvasive ventilation was applied to the patients immediately in paediatric emergency service. All of the patient's clinical and radiological findings recovered rapidly. There are limited reports about use of noninvasive ventilation in nonfatal drowning cases in the paediatric emergency department. We emphasize that the early application of noninvasive ventilation should be a preventive method for reducing the morbidity of nonfatal drowning cases. (Hong Kong j.emerg.med. 2016;23:42-46)

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group

“…Four studies were identified that examined the use of ventilation strategies in 93 adults or children after drowning. [81][82][83][84] The studies included 1 retrospective observational study with 88 patients, 84 1 case series comprising 3 children, 81 and 2 case reports. 82,83 All articles reported survival status at hospital discharge.…”

“…82,84 Three studies reported the feasibility of noninvasive ventilation (NIV) use in patients with respiratory failure after drowning. 81,82,84 In a multicenter, retrospective observational study across 7 French intensive care units (ICUs), 48 adults received NIV (both continuous positive airway pressure and bilevel positive airway pressure; average positive end-expiratory pressure [PEEP], 8±2 cm H 2 O) to treat moderate to severe lung injury (mean Pao 2 /Fio 2 ratio, 156 mm Hg). 84 Compared with patients treated with invasive mechanical ventilation, those receiving NIV had a better initial neurological and hemodynamic status.…”

Drowning induced acute respiratory failure: A case report

“…A beneficial effect of positive end expiratory pressure (PEEP) has indeed been reported in rare animal studies [8]. The favorable effect of early administration of PEEP has not been clinically demonstrated but is regularly discussed in few case reports and retrospective studies [9][10][11][12][13][14]. Further prospective evaluation on ventilator supports (NIV, high-flow oxygen device) is needed.…”

Management for the Drowning Patient

“…Although all grade 4 cases need oral tracheal intubation, a few grade 3 drowning cases will tolerate noninvasive ventilatory support 18,39,42,43 provided their conscious level allows. Patients should be anesthetized to tolerate intubation and artificial mechanical ventilation.…”

“…18,44 Respiratory System ventilation are appropriate weaning strategies if pulmonary and psychological status allows. 42,43 Pools, rivers, and beaches generally have insufficient bacteria colonization to promote pneumonia in the immediate postdrowning period. 47 Pneumonia is often misdiagnosed initially because of the early radiographic appearance of water in the lungs, with few patients actually requiring antibiotic therapy (12%).…”