Near-drowning: clinical course of lung injury in adults.
OBJECTIVE
Although anoxic encephalopathy is the most dreaded consequence of submersion accidents, respiratory involvement is also very common in these patients. Nevertheless, few data are available about the clinical course and resolution of lung injury in adult victims of near-drowning. Our goal was to study the clinical manifestations of near-drowning and the course of respiratory involvement in a retrospective cohort of adult, mostly elderly patients.


METHODS
Our study included adult patients who were hospitalized after near-drowning in seawater over an 8-year period. Forty-three patients (26 female, 17 male), with an age range of 18-88 years old, were studied. Most (79%) of the patients were elderly (>60 years).


RESULTS
In the Emergency Department two patients were comatose and required intubation. Another patient was intubated within the first 24 h because of ARDS. At presentation, all patients but two had a PaO(2)/FiO(2) < 300, while ARDS was present in 17 and acute lung injury in 15 cases. The nine remaining hypoxemic patients had either focal infiltrates or a negative chest X-ray. Superimposed pneumonia was observed in four patients and resulted in a protracted hospital stay. Improvement of lung injury was rapid in most cases: by day 4 resolution of hypoxemia was observed in 33/43 (76.7%) of the cases and resolution of radiographic findings in 66.6%. Duration of hospitalization varied from 2 to 14 days (mean = 5.2 +/- 0.5 days). One patient with coma died due to ventilator-associated pneumonia (mortality = 2.3%).


CONCLUSIONS
Respiratory manifestations of near-drowning in adult immersion victims are often severe. Nevertheless, in noncomatose patients at least, intubation can often be avoided and quick improvement is the rule while a good outcome is usually expected even in elderly patients.
Gregorakos
Leonidas
L
Athens University School of Nursing, and Intensive Care Unit, KAT Hospital, Attica, Greece.
Markou
Nikolaos
N
Psalida
Vasiliki
V
Kanakaki
Maria
M
Alexopoulou
Anastasia
A
Sotiriou
Eva
E
Damianos
Anastasios
A
Myrianthefs
Pavlos
P
D055371:Acute Lung Injury / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003128:Coma / Q000209:etiology; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015701:Near Drowning / Q000150:complications*; D011014:Pneumonia / Q000209:etiology; D011654:Pulmonary Edema / Q000209:etiology; D011859:Radiography; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012623:Seawater; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult