Therapeutic Approaches and Mortality in Acute Respiratory Failure due to Drowning

Drowning is a process of submersion and can lead to respiratory failure. Annually, there are an estimated 320 000 deaths worldwide due to drowning, in addition to nonfatal drowning events. There are limited data for respiratory failure due to drowning and its prognosis in Turkey. The aim of this study was to identify the therapeutic modalities used for acute respiratory failure (ARF) due to drowning, and its prognosis in hospitalized patients.

All adult drowning cases (according to the International Classification of Disease (ICD) diagnosis code) who were admitted to either the emergency department (ED) or the intensive care units (ICU), or the pulmonology inpatient clinics between 2008 and 2018 were included in the study. Data for demographic characteristics, radiologic evaluations, respiratory support and mechanical ventilation, hospital stay duration, and hospital mortality were retrospectively collected from hospital records.

A total of 117 patients (47 females, 70 males, mean age: 57.3 years) were included in the study. The drowning accidents most commonly occurred in summer (86.3%). Of them, 31 victims (26.4%) were admitted to ICU due to severe respiratory failure. The mean pH was 7.32, and PaO2 was 69.13 mmHg in the arterial blood gas at admission. Invasive and noninvasive mechanical ventilation were performed in 24.7% and 25.6% of the patients respectively. The PaO2/FiO2 of 106 patients (who had accessible FiO2 values) were >300 in 12 (11%), 201-300 in 32 (30%), 101-200 in 49 (46%), and <100 in 13 (12%) patients. Bilateral opacities were observed in 85.4% of the patients. Cardiopulmonary resuscitation was performed in 8 (6.8%) patients. The hospital mortality rate was 6%.

The present study results show that with appropriate therapeutic and support strategies, respiratory failure due to drowning can be treated successfully.