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Pentobarbital therapy does not improve neurologic outcome in nearly drowned, flaccid-comatose children
1Pediatric Critical Care Center, Miller Children's Hospital of Long Beach, CA 90801-1428.
Insights
Pentobarbital therapy did not improve neurological outcomes in nearly drowned children. Hypothermia alone may be responsible for any observed benefits in drowning victims.
Area of Science:
- Pediatric Critical Care
- Neurology
- Emergency Medicine
Background:
- Near-drowning incidents in children can lead to severe neurological deficits.
- Pentobarbital therapy has been explored as a neuroprotective agent in comatose patients.
Purpose of the Study:
- To prospectively evaluate the efficacy of pentobarbital therapy in nearly drowned, flaccid-comatose children.
- To determine if pentobarbital improves neurological outcomes compared to hypothermia alone.
Main Methods:
- A prospective study involving 31 nearly drowned children in a flaccid coma.
- Two sequential treatment groups: Group A (hypothermia and pentobarbital) and Group B (hypothermia only).
- All patients received conventional therapy, including controlled ventilation and fluid restriction.
Main Results:
- No statistically significant differences were found between groups in terms of complete recovery, survival with brain damage, or mortality rates (P > .05).
- Group A (pentobarbital): 37% complete recovery, 37% severe brain damage, 26% died.
- Group B (no pentobarbital): 40% complete recovery, 40% brain damage, 20% died.
Conclusions:
- Pentobarbital therapy does not appear to improve neurological outcomes in nearly drowned, flaccid-comatose children.
- Observed benefits in previous studies may be attributable to hypothermia alone.
- Pentobarbital therapy may not be justified for this patient population.
Abstract:
The effect of pentobarbital therapy was studied prospectively in 31 nearly drowned children in a flaccid state of coma. Each child was assigned to one of two sequential treatment groups. Group A: 16 children were treated with hypothermia and IV pentobarbital, achieving serum levels greater than 25 mu/mL within 48 hours of admission. Group B: 15 children were treated with hypothermia but no pentobarbital. All patients received "conventional therapy" (ie, PaCO2 20 to 25 mm Hg, PaO2 90 to 100 mm Hg, fluid restriction, pancuronium bromide, and furosemide or mannitol). Analysis of variance failed to detect differences for age, estimated time of submersion, arterial pH, core temperature, and mean intracranial pressure between the patients prior to treatment with pentobarbital. In Group A, six patients (37%) recovered completely and were neurologically intact, six patients (37%) had severe brain damage and four patients (26%) died. In Group B, six patients (40%) recovered completely, six patients (40%) survived with brain damage, and three patients (20%) died. There were no statistical differences between the two groups (P greater than .05, chi 2 analysis) for the mortality rate, survival with brain damage, and complete recovery. The results suggest that: (1) pentobarbital therapy does not improve neurologic outcome for nearly drowned, flaccid-comatose children; (2) previous claims implying better outcome with hypothermia combined with pentobarbital therapy may be attributed to the effect of hypothermia alone; and (3) pentobarbital therapy may not be justified in nearly drowned, flaccid-comatose victims.