Clinical course and prognostic signs in near-drowned patients

The clinical course and outcome of 49 consecutive near-drowned patients is presented. All the immersions occurred in fresh water. 37 patients (76%) survived. All 28 patients who were conscious upon admission to hospital recovered fully. However, 13 of these developed pulmonary infiltrates on chest X-ray, three of them with severe respiratory distress syndrome (ARDS) requiring respirator treatment. On entering the emergency station 16 patients had cardiac arrest. 15 of these were successfully resuscitated, of whom, however, 11 died later, most from hypoxic brain damage. Among unconscious patients, the non-survivors had on arrival an average lower rectal temperature than the survivors. The following factors during intensive care correlated with bad prognosis: low PaO2/FiO2, low serum protein concentration and disturbances in renal function. Furthermore, the findings of this study suggest that although a specific near-drowned patient has on admission most abnormal laboratory values, these do not predict his fate, but effective treatment has to be given.