Citation

Michelet P, Bouzana F, Charmensat O, Tiger F, Durand-Gasselin J, Hraiech S, Jaber S, Dellamonica J, Ichai C. Eur. J. Emerg. Med. 2015; 24(4): 295-300.

Affiliation

aEmergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille bIntensive Care Unit, Antibe General Hospital, Antibe cIntensive Care Unit, Toulon-La Seyne General Hospital, Toulon-La Seyne dRespiratory Distress and Infectious Intensive Care Unit, North Hospital, Aix-Marseille University, Marseille eIntensive Care and Anesthesia Department, Saint-Eloi Hospital, Montpellier University, Montpellier fMedical Intensive Care Unit, l'Archet Hospital, Nice University gIntensive Care Unit, Pasteur 2 Hospital, Nice University, Nice, France.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/MEJ.0000000000000362

PMID

26684548

Abstract

OBJECTIVES: Despite the extensive literature on drowning, clinical data are still lacking on the best medical strategy to use. Acute respiratory failure (ARF) is the main component of drowning pathophysiology. The objectives of this multicenter study were to analyze the clinical course of drowning-related ARF patients and to describe the efficacy of the ventilatory strategies used.

METHODS: Medical records of drowned adult patients admitted in seven ICUs after prehospital emergency medical care during three consecutive summer periods were retrospectively analyzed.

RESULTS: Among the 126 patients (58±21 years) admitted, 38 patients with cardiac arrest at the scene were not analyzed, 26 received mechanical ventilation (MV), and 48 patients received noninvasive ventilation (NIV). Compared with patients placed under MV, the NIV patients presented a better initial neurological (Glasgow Coma Scale of 7±4 vs. 12±3, P<0.05) and hemodynamic status from the prehospital stage (mean arterial pressure of 77±18 vs. 96±18, P<0.001). With comparable ARF-related hypoxemia to MV, the NIV was maintained with success in 92% (44/48). Both MV and NIV were associated with rapid improvement of oxygenation and short ICU length of stay [3 (1-14) and 2 (1-7), respectively].

CONCLUSION: Despite the absence of recommendation for NIV use in case of drowning-related ARF, this technique was often used with safety and efficacy. The decision for NIV use was mainly based on the preserved or improved neurological status.

Language: en