The Utility of Non-Invasive Nasal Positive Pressure Ventilation for Acute Respiratory Distress Syndrome in Near Drowning Patients

Abstract

Purpose: Near drowning refers to immediate survival after asphyxia due to submersion or immersion in water, which is a crucial public safety problem worldwide. Acute lung injury or acute respiratory distress syndrome (ARDS) is a common complication of near drowning. The purpose of this study was to investigate the feasibility and effectiveness of noninvasive nasal positive pressure ventilation (NINPPV). methods: This retrospective study was conducted at a tertiary emergency department. NINPPV was administered for moderate ARDS caused by submersion or immersion in patients who were older than 18 years, from January 2015 to December 2018. We collected the demographic (age, sex, length of hospital stay, and outcome), laboratory (arterial blood gas, lactate, oxygen saturation, partial pressure of oxygen divided by the fraction of inspired oxygen, complete blood count, blood urea nitrogen, and creatinine), and clinical data (acute lung injury index and ventilator failure) of the patients. A statistical analysis was performed using Statistical Package for the Social Sciences version 20.0 for Windows. results: NINPPV treatment was provided to 57 patients for near drowning, 45 of whom (78.9%) were successfully treated without complications; in 12 (21.1%), treatment was changed to invasive mechanical ventilation within 48 hours due to ARDS or acute kidney injury. NINPPV treatment was successful in 31 (75.6%) out of 41 sea-water near drowning patients. They were more difficult to treat with NINPPV compared with the fresh-water near drowning patients (p<0.05). Conclusions: NINPPV would be useful and feasible as the initial treatment of moderate ARDS caused by near drowning.

Treatment of the lung injury of drowning: a systematic review

“…Data presented included 1093 (55.4%) males and 545 (27.6%) females and were similarly incomplete with regards to age groups in seven papers [ 10 , 16 , 31 , 32 , 34 , 36 , 37 ], with a minimum of 675 (34.5%) children included. Studies were predominately (30/41, 73.2%) from intensive (critical) care units [ 10 , 16 , 20 – 31 , 34 – 51 ], 6/41 (14.6%) from inpatient units [ 9 , 15 , 17 , 18 , 41 , 52 ] and five (12.2%) studies were based in the Emergency Department [ 19 , 32 , 33 , 53 , 54 ]. Three studies utilised the Utstein Style for drowning [ 28 , 29 , 44 ].…”

“…A total of 17 papers were identified where the lung injury of drowning was the focus of the research question [ 9 , 10 , 20 – 22 , 28 – 31 , 36 , 37 , 39 , 43 , 44 , 47 , 50 , 51 , 53 ]. Twenty-four papers where the lung injury of drowning was not the focus of the research question that nevertheless included information relevant to the review were included [ 15 – 19 , 23 – 27 , 32 – 35 , 37 , 38 , 40 , 41 , 45 , 46 , 48 , 49 , 52 , 54 ].…”

“…Insufficient studies were free of these issues to allow meta-analysis. Extracorporeal life support (ECLS) was the most common theme (21 articles) [ 20 , 21 , 23 – 27 , 31 , 34 , 35 , 37 , 43 – 51 ] followed by ventilatory strategies (14 articles) [ 9 , 10 , 15 , 17 , 19 , 28 , 29 , 32 , 38 – 41 , 53 , 54 ], the use of prophylactic antibiotics to prevent aspiration or early onset post-drowning pneumonia (14 articles) [ 9 , 10 , 16 – 18 , 30 , 33 , 36 , 38 – 41 ], the use of corticosteroids (7 articles) [ 16 , 18 , 33 , 36 , 40 , 41 , 52 ] and the use of diuretics (5 articles) [ 9 , 18 , 40 , 41 , 52 ]. A summary of the aims, the population studied, the study setting, treatment strategies, methodology, results and GRADE level of the selected studies is included in Additional file 3 .…”

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%).…”