Treatment of the lung injury of drowning: a systematic review

Abstract

Background Drowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. This systematic review addressed the following question: In drowning patients with lung injury, what is the evidence from primary studies regarding treatment strategies and subsequent patient outcomes? Methods The search strategy utilised PRISMA guidelines. Databases searched were MEDLINE, EMBASE, CINAHL, Web of Science and SCOPUS. There were no restrictions on publication date or age of participants. Quality of evidence was evaluated using GRADE methodology. Results Forty-one papers were included. The quality of evidence was very low. Seventeen papers addressed the lung injury of drowning in their research question and 24 had less specific research questions, however included relevant outcome data. There were 21 studies regarding extra-corporeal life support, 14 papers covering the theme of ventilation strategies, 14 addressed antibiotic use, seven papers addressed steroid use and five studies investigating diuretic use. There were no clinical trials. One retrospective comparison of therapeutic strategies was found. There was insufficient evidence to make recommendations as to best practice when supplemental oxygen alone is insufficient. Mechanical ventilation is associated with barotrauma in drowning patients, but the evidence predates the practice of lung protective ventilation. There was insufficient evidence to make recommendations regarding adjuvant therapies. Conclusions Treating the lung injury of drowning has a limited evidentiary basis. There is an urgent need for comparative studies of therapeutic strategies in drowning.

Drowning case complicated with a cardiopulmonary arrest and severe ARDS saved with a good neurological outcome by ECMO: A case report

“… 10 In recent years, several extensive literature reviews have been published on the treatment of drowning, including systematic and scoping reviews. 4 , 11 Thom et al reported that the use of ECMO is uncommon for drowning, and that there is a lack of evidence informing its use and efficacy in the management of drowning patients. 11 Therefore, it is crucial to record cases of ECMO for drowning, such as this present case, to build high‐quality evidence.…”

“… 4 , 11 Thom et al reported that the use of ECMO is uncommon for drowning, and that there is a lack of evidence informing its use and efficacy in the management of drowning patients. 11 Therefore, it is crucial to record cases of ECMO for drowning, such as this present case, to build high‐quality evidence.…”

“…A study of 251 drowning patients who used ECMO between 1986 and 2015 reported a survival rate of 57.0% for patients who regained ROSC before ECMO, and 23.4% for those who received extracorporeal cardiopulmonary resuscitation 10 . In recent years, several extensive literature reviews have been published on the treatment of drowning, including systematic and scoping reviews 4,11 . Thom et al reported that the use of ECMO is uncommon for drowning, and that there is a lack of evidence informing its use and efficacy in the management of drowning patients 11 .…”

Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study

“…However, we observed a higher proportion of patients developing ARDS in freshwater patients that could be related to the duration of immersion and the higher proportion of drowning-related cardiac arrest in these patients. Moreover, a recent review on pulmonary lesions induced by drowning highlighted the lack of evidence regarding the treatment of drowning associated ARDS [ 30 ].…”

“Dirty drowning” related lung injury in a paediatric intensive care unit

“…Therefore, beyond early airway injury and cerebral hypoxia, infectious complications can have a profound influence on the clinical outcome. Late deaths from fungal Central Nervous System (CNS) complications have also been described, underlining the need for early fungal investigations and treatment 2,6 A recent review paper regarding near‐drowning intensive care 7 could not demonstrate a significant advantage when using prophylactic antibiotics in near‐drowning patients and highly contaminated submersion water. However, for dirty‐drowned children, both antibiotic and antimycotic prophylaxis appear mandatory.…”