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The Parameters Affecting the Outcome in Drowning Cases in Intensive Care Unit: Eight Years of Retrospective Patient Data
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Original Research
VOLUME: 18 ISSUE: 1
P: 13-20
March 2020

The Parameters Affecting the Outcome in Drowning Cases in Intensive Care Unit: Eight Years of Retrospective Patient Data

J Turk Soc Intens Care 2020;18(1):13-20
DOI: 10.4274/tybd.galenos.2019.34735
Mehtap Pehlivanlar Küçük 1
Ahmet Oğuzhan Küçük 2
Çağatay Erman Öztürk 3
Özgür Kömürcü 1
İlkay Koray Bayrak 4
Fatma Ülger 1
1. Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Anesteziyoloji Ve Reanimasyon Anabilim Dalı, Yoğun Bakım Bilim Dalı, Samsun, 55270, Türkiye
2. Karadeniz Teknik Üniversitesi, Tıp Fakültesi, Anesteziyoloji Ve Reanimasyon Anabilim Dalı, Yoğun Bakım Bilim Dalı, Trabzon, 61080, Türkiye
3. Sağlık Bilimlieri Üniversitesi, Samsun Eğitim Araştırma Hastanesi,Yoğun bakım kliniği,Türkiye Samsun 55270
4. Ondokuz Mayis Universitesi, Tip Fakultesi, Radyoloji Anabilim Dali, Samsun, 55270, Turkiye
5. Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Yoğun Bakım Bilim Dalı, Samsun, Türkiye
6. Karadeniz Teknik Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Yoğun Bakım Bilim Dalı, Trabzon, Türkiye
7. Sağlık Bilimlieri Üniversitesi, Samsun Eğitim ve Araştırma Hastanesi, Yoğun Bakım Kliniği, Samsun, Türkiye
8. Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Samsun, Türkiye
9. Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Yoğun Bakım Bilim Dalı, Samsun, Türkiye
10. Karadeniz Teknik Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Yoğun Bakım Bilim Dalı, Trabzon, Türkiye
11. Sağlık Bilimleri Üniversitesi, Samsun Eğitim ve Araştırma Hastanesi, Yoğun Bakım Kliniği, Samsun, Türkiye
12. Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Samsun, Türkiye
No information available.
No information available
Received Date: 28.10.2018
Accepted Date: 04.04.2019
Publish Date: 20.02.2020
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ABSTRACT

Objective:

Drowning is a common and important cause of accidental deaths. Complications and mortality rates are high in patients requiring intensive care unit (ICU) support. The aim of our study was to determine the clinical course and treatment efficacy of a limited number of patients with acute respiratory failure and multiorgan failure due to drowning.

Materials and Methods:

Patients who were hospitalized >24 hours in the ICU between January 2010 and August 2018 and who met the inclusion criteria were retrospectively analyzed.

Results:

Of 103 patients admitted to the emergency department over an 8-year period, 13 required intensive care support. Five patients (38.4%) died and eight patients (61.5%) were discharged. Steroids were used in six patients (46.2%), but no statistically significant difference was found in terms of mortality (p=0.592). The presence of diffuse cerebral edema in five patients (38.5%) was associated with a statistically higher mortality rate compared to six patients (46.2%) with normal findings (p=0.003). Mechanical ventilation was performed with synchronized intermittent mandatory ventilation mode in nine patients (69.2%) and with airway pressure-release ventilation (APRV) mode in four patients (31.8%). According to our clinical observations, apparent radiological improvement was detected in patients who received mechanical ventilation with APRV mode.

Conclusion:

Neither steroids nor prophylactic antibiotherapy are found effective on mortality rates. In addition to these ineffective interventions, mechanical ventilation strategies, the degree of metabolic acidosis at admission and the neurological status of the patient may be considered as variable clinical parameters that may affect patient outcome.

Keywords: APRV, drowning, mortality, predictors, intensive care unit

References

1
Papa L, Hoelle R, Idris A. Systematic review of definitions for drowning incidents. Resuscitation. 2005;65:255-64.
2
Salomez F, Vincent JL. Drowning: a review of epidemiology, pathophysiology, treatment and prevention. Resuscitation 2004;63:261-8.
3
Bierens JJ, Knape JT, Gelissen HP. Drowning. Curr Opin Crit Care 2002;8:578-86.
4
Orlowski JP. Drowning, near-drowning, and ice-water drowning. Jama 1988;260:390-1.
5
Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S829-61.
6
Idris AH, Bierens J, Perkins GD, Wenzel V, Nadkarni V, Morley P, et al. 2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement. Resuscitation 2017;118:147-58.
7
Youn CS, Choi SP, Yim HW, Park KN. Out-of-hospital cardiac arrest due to drowning: An Utstein Style report of 10 years of experience from St. Mary’s Hospital. Resuscitation 2009;80:778-83.
8
Szpilman D, Bierens JJ, Handley AJ, Orlowski JP. Drowning. N Engl J Med 2012;366:2102-10.
9
Force TADT. Acute Respiratory Distress Syndrome: The Berlin DefinitionThe Berlin Definition of ARDS. Jama 2012;307:2526-33.
10
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama 2016;315:801-10.
11
Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama 2012;307:2526-33.
12
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med 2017;45:486-552.
13
Grmec S, Strnad M, Podgorsek D. Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest. Int J Emerg Med 2009;2:7-12.
14
Orlowski JP, Abulleil MM, Phillips JM. The hemodynamic and cardiovascular effects of near-drowning in hypotonic, isotonic, or hypertonic solutions. Ann Emerg Med 1989;18:1044-9.
15
Sarnaik AP, Preston G, Lieh-Lai M, Eisenbrey AB. Intracranial pressure and cerebral perfusion pressure in near-drowning. Crit Care Med 1985;13:224-7.
16
Eggink WF, Bruining HA. Respiratory distress syndrome caused by near- or secondary drowning and treatment by positive end-expiratory pressure ventilation. Neth J Med 1977;20:162-7.
17
Burke CR, Chan T, Brogan TV, Lequier L, Thiagarajan RR, Rycus PT, et al. Extracorporeal life support for victims of drowning. Resuscitation 2016;104:19-23.
18
Thalmann M, Trampitsch E, Haberfellner N, Eisendle E, Kraschl R, Kobinia G. Resuscitation in near drowning with extracorporeal membrane oxygenation. Ann Thorac Surg 2001;72:607-8.
19
Branson RD, Johannigman JA. What is the evidence base for the newer ventilation modes? Respir Care 2004;49:742-60.
20
Michelet P, Bouzana F, Charmensat O, Tiger F, Durand-Gasselin J, Hraiech S, et al. Acute respiratory failure after drowning: a retrospective multicenter survey. Eur J Emerg Med 2017;24:295-300.
21
Tutanç M, Bilen Gl, Zeren C, Boşnak M, Karakuş A. Cases of Drowning and Near-Drowning in Pediatric Intensive Care Unit. J For Med 2011;25:177-82.
22
Gilbert M, Busund R, Skagseth A, Nilsen PA, Solbo JP. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet 2000;355:375-6.
23
Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases. Chest 1997;112:660-5.
24
Szpilman D, Soares M. In-water resuscitation--is it worthwhile? Resuscitation 2004;63:25-31.
25
Choi SP, Youn CS, Park KN, Wee JH, Park JH, Oh SH, et al. Therapeutic hypothermia in adult cardiac arrest because of drowning. Acta Anaesthesiol Scand 2012;56:116-23.
26
Moler FW, Hutchison JS, Nadkarni VM, Silverstein FS, Meert KL, Holubkov R, et al. Targeted Temperature Management After Pediatric Cardiac Arrest Due To Drowning: Outcomes and Complications. Pediatr Crit Care Med 2016;17:712-20.
27
Spicer ST, Quinn D, Nyi Nyi NN, Nankivell BJ, Hayes JM, Savdie E. Acute renal impairment after immersion and near-drowning. J Am Soc Nephrol 1999;10:382-6.
28
Ibsen LM, Koch T. Submersion and asphyxial injury. Crit Care Med 2002;30(11 Suppl):S402-8.
29
Orlowski JP, Szpilman D. Drowning. Rescue, resuscitation, and reanimation. Pediatr Clin North Am 2001;48:627-46.
30
Cerland L, Megarbane B, Kallel H, Brouste Y, Mehdaoui H, Resiere D. Incidence and Consequences of Near-Drowning-Related Pneumonia-A Descriptive Series from Martinique, French West Indies. Int J Environ Res Public Health 2017;14.
31
Ender PT, Dolan MJ. Pneumonia associated with near-drowning. Clin Infect Dis 1997;25:896-907.
32
Gökırmak M, Avcı H, Kalkan Ş, Yıldırım Z. Tatlı Su Aspirasyonuna Bağlı Olarak Gelişen Bir ARDS Olgusu. Yoğun Bakım Dergisi 2006;6:52-7.
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