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[Triage and treatment in juvenile drowning accidents]
Insights
Improved pediatric near-drowning outcomes are possible with advanced neurointensive care. Early triage and aggressive treatment, including artificial ventilation and invasive neurointensive care, significantly enhance survival and recovery in comatose children.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Emergency Medicine
Context:
- Childhood near-drowning historically had a poor prognosis with high mortality and severe neurological deficits.
- Introduction of invasive neurointensive care methods in the late 1970s offered new therapeutic possibilities.
- Pediatric intensive care units (PICUs) began implementing advanced monitoring and interventions for near-drowning cases.
Purpose:
- To evaluate the impact of invasive neurointensive care on the prognosis of children experiencing near-drowning.
- To report outcomes from a series of pediatric near-drowning cases treated with advanced intensive care methods.
- To assess the effectiveness of specific neurointensive care techniques in improving survival and neurological function.
Summary:
- A case series of 14 children with near-drowning (1978-1980) treated with invasive neurointensive care, including hyperventilation, cooling, barbiturates, and intracranial pressure monitoring.
- Patients were categorized based on treatment intensity: clinical observation, artificial ventilation, and artificial ventilation with invasive neurointensive care.
- Two brain-dead patients with cardiovascular instability died; all other 12 survivors had excellent outcomes (11 completely normal, 1 slightly retarded).
Impact:
- Demonstrates a significantly improved prognosis for childhood near-drowning with the application of advanced neurointensive care.
- Highlights the importance of prompt triage, artificial ventilation, and invasive neurointensive care for deeply comatose near-drowning victims.
- Suggests that modern intensive care strategies can drastically reduce mortality and long-term neurological damage in pediatric near-drowning incidents.
Abstract:
Until 1977 the prognosis in childhood near drowning was rather poor. Many children died or survived permanently damaged by hypoxic encephalopathy. In the late seventies new methods of invasive neurointensive care were introduced in pediatric intensive care and were used in selected cases of near drowning. In one center (Hospital for Sick Children, Toronto) the prognosis in those children who remained comatose after the initial resuscitation was significantly improved with these methods. 14 personally observed cases of near-drowning are reported (1978-1980). During this time we were using invasive neurointensive care methods in selected cases (hyperventilation, cooling, barbiturates and others, combined with continuous intracranial pressure monitoring). Four children came under the category "clinical observation", 3 the category "artificial ventilation" (mainly for pulmonary reasons) and 5 the category "artificial ventilation and invasive neurointensive care". Two children were "brain dead" and showed significant cardiovascular instability at the time of ICU admission. Both died, while all the others survived: 11 were completely normal and 1 child was slightly retarded. We conclude that the prognosis in childhood near drowning can be greatly improved by triage, generous use of artificial ventilation and invasive neurointensive care in those children who remain deeply comatose after near drowning.