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Intensive care after fresh water immersion accidents in children
Insights
This study details a therapeutic approach for children in deep coma after freshwater immersion, focusing on intracranial pressure management. The intensive treatment protocol led to good recovery in all six pediatric patients, with two requiring rehabilitation.
Area of Science:
- Pediatric critical care
- Neurology
- Emergency medicine
Background:
- Freshwater immersion accidents can lead to severe brain injury and increased intracranial pressure (ICP) in children.
- Managing deep coma and elevated ICP is crucial for improving outcomes in pediatric drowning victims.
Observation:
- Six children with deep coma post-freshwater immersion presented with elevated ICP.
- All patients developed pulmonary complications, including pulmonary edema, broncho-pneumonia, and acute respiratory distress syndrome.
Findings:
- An intensive management strategy involving controlled ventilation, normothermia, fluid restriction, dexamethasone, and barbiturates effectively controlled ICP in all patients.
- Despite severe initial presentation and complications, all six children survived.
Implications:
- This therapeutic regimen demonstrates the potential for good recovery in children with severe brain injury from freshwater immersion.
- Early and aggressive management of intracranial pressure is vital for pediatric drowning survivors.
- Further research into optimizing barbiturate dosage and managing secondary complications is warranted.
Abstract:
Six children who remained in deep coma after immersion accidents in fresh water received therapy to maintain normal intracranial pressure (ICP). This involved controlled ventilation to ensure hypocapnia and hyperoxaemia, maintenance of low normothermia, fluid restriction, dexamethasone (1-1.5 mg/kg initially, 1-1.5 mg/kg/day as maintenance) and barbiturates (phenobarbitone and thiopentone). The latter were given in a wide range of dosage. Increased ICP was common to all patients, but could always be kept at acceptable levels. All patients suffered from pulmonary oedema; three developed broncho-pneumonia and two developed adult respiratory distress syndrome. All children survived with good recovery, two needed active rehabilitation for several months.