Document Detail


Near drowning: consensus and controversies in pulmonary and cerebral resuscitation.
MedLine Citation:
PMID:  3308778     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
By consensus, the most clinically important consequence of near drowning is hypoxemia. Whether it is due to physiologic shunting induced by diffuse alveolar flooding from saltwater aspiration or to diffuse atelectasis induced by surfactant inactivation from freshwater aspiration, both physiologic disturbances can be reversed with the institution of positive-pressure breathing in the form of PEEP or CPAP, which should be the mainstay of pulmonary management of respiratory insufficiency in these patients. The use of prophylactic antibiotics or corticosteroids as an adjunct in the management of pulmonary insufficiency resulting from near drowning is not warranted, may be detrimental, and remains controversial. The most crucial clinical consequence of the hypoxemia resulting from near drowning is cerebral injury and the consequent neurologic sequelae. The general consensus supported by large clinical studies is that near-drowning victims who, after initial resuscitation, are spontaneously breathing and are not comatose have a uniformly benign neurologic outcome. A significant subset of comatose near-drowning victims survive with eventually normal neurologic recovery when routine aggressive supportive intensive care is administered. Uncontrolled studies reporting improved outcomes with the institution of complex cerebral salvage techniques, such as induction of hypothermia, intracerebral pressure monitoring, induction of barbiturate coma, and the use of corticosteroids and osmotic diuretics, remain controversial. It is now clear that neither induced hypothermia nor barbiturate coma improves survival or neurologic outcome in these patients and may be detrimental.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
R J Gonzalez-Rothi
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Heart & lung : the journal of critical care     Volume:  16     ISSN:  0147-9563     ISO Abbreviation:  Heart Lung     Publication Date:  1987 Sep 
Date Detail:
Created Date:  1987-10-26     Completed Date:  1987-10-26     Revised Date:  2006-08-28    
Medline Journal Info:
Nlm Unique ID:  0330057     Medline TA:  Heart Lung     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  474-82     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, University of Florida, Gainesville.
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MeSH Terms
Descriptor/Qualifier:
Brain / physiopathology
Critical Care
Drowning / drug therapy,  physiopathology,  therapy*
Humans
Lung / physiopathology
Positive-Pressure Respiration
Prognosis
Resuscitation*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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