title: Acute respiratory failure after drowning: a retrospective multicenter survey.
abstract: OBJECTIVE
  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].
  
  
  CONCLUSIONS
  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.
authors.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.
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.forename: Fouad
authors.initials: F
authors.lastname: Bouzana
authors.forename: Olivia
authors.initials: O
authors.lastname: Charmensat
authors.forename: Fabrice
authors.initials: F
authors.lastname: Tiger
authors.forename: Jacques
authors.initials: J
authors.lastname: Durand-Gasselin
authors.forename: Sami
authors.initials: S
authors.lastname: Hraiech
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Jean
authors.initials: J
authors.lastname: Dellamonica
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
mesh_terms: D004332:Drowning / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome