The identification of risk factors contributing to the development of pulmonary oedema, pneumonia and late mortality in submersion victims.
A retrospective study of 125 submersion victims.Setting: The medical intensive care unit in a university hospital.
Baseline examination on admission consisted of history, physical examination, arterial blood gas analysis and a chest radiograph. Patients were then classified into four groups: class I, baseline examination negative; class II, baseline examination positive, but mechanical ventilation not needed on admission; class III, mechanical ventilation required on admission; class IV, patients suffering form cardiopulmonary arrest. All patients who were not succesfully resuscitated or who had expired with-in 24 h after admission were excluded for determination of the risk of pulmonary oedema and pneumonia.
Class I patients did not develop pulmonary complications; neither pulmonary oedema nor pneumonia occurred in this group. In the remaining classes the incidence of pulmonary oedema was 72% and that of pneumonia, 14.7%. Stepwise logistic regression showed that pulmonary oedema was related to the type of water (seawater, ditch water, swimming pool) victims were submerged in and to the neurological state both at the time of rescue and on admission. The development of pneumonia was related to the use of mechanical ventilation (the risk was 52%). Pneumonia was not related to neurological state at the time of rescue or on admission, to body temperature on admission, to the prohylactic administration of antibiotics or to the use of corticosteroids. Mortality was high in class IV patients, but low in all other patients. Early mortality was 18.4% while late mortality was 5.6%.
There is no need to hospitalise submersion victims when there are no signs or symptoms of aspiration upon arrival in the emergency room. All other patients should be admitted to an intensive care unit. The risk of pneumonia is high when mechanical ventilation is necessary. Mortality is high in patients with circulatory arrest on admission, but low in all other patients.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Modell JH (1993) Current concepts: drowning. N Engl J Med 328: 253–256
Modell JH, Graves SA, Kuck EJ (1980) Near-drowning: correlation of consciousness and survival. Can Anaesth Soc J 27: 211–215
Simcock AD (1986) Treatment of neardrowning-a review of 130 cases. Anaesthesia 41: 643–648
Andrews CP, Coalson JJ, Smith JD, Johnson WG (1981) Diagnosis of bacterial nosocomial pneumonia in acute, diffuse lung injury. Chest 80: 254–258
Salata RA, Lederman MM, Shlaes DM, Jacobs MR, Eckestein E, Tweardy D et al. (1987) Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. Am Rev Respir Dis 135: 426–432
Rosenbaum HT, Thompson WL, Fuller RH (1964) Radiographic pulmonary changes in near-drowning. Radiology 83: 306–313
Hunter TB, Whitehouse WM (1974) Fresh water near-drowning: radiological aspects. Radiology 112: 51–56
Wunderlich P, Rupperecht E, Trefftz F, Thomsen H, Burkhardt J (1985) Chest radiographs of near-drowned children. Pediatr Radiol 15: 297–299
Simcock AD (1989) The resuscitation of submersion victims. ACP 2: 293–298
Martin TG (1989) Near-drowning and cold water immersion. Ann Emerg Med 13: 263–267
Model JH, Graves SA, Ketover A (1976) Clinical course of 91 consecutive near-drowning victims. Chest 70: 231–238
Pratt FD, Haynes BE (1986) Incidence of “secondary drowning” after salt water submersion. Ann Emerg Med 15: 1084–1087
Schiavon F, Nardini S, Bossi A, Bezzegato L (1990) Radiologica picture of the thorax in acute asphysia cuased by near drowning. Radiol Med 80: 24–28
Stewart RD (1989) Submersion incidents: drowning and near-drowning. In: Auerbach PS, Geehr EC (eds) Management of wilderness and environmental emergencies. 2nd edn. Mosby, St Louis, pp 908–932
Gonzalez-Rothi RJ (1987) Near drowning: consensus and controversies in pulmonary and cerebral resuscitation. Heat Lung 16: 474–482
Klein JJ, Dalligna OT, Van Dijl W De Jager AEJ, Meinesz AF, Snoek WJ, Sluiter HJ (1979) Bijna-verdrinking: een analyse van 60 patiënten. Ned T Geneesk 20: 162–167
Eggink WF, Bruinink HA (1977) Respiratory distress syndrome caused by nearor secondary drowning and treatment by positive pressure ventilation. Neth J Med 20: 162–167
Oakes DD, Sherck JP, Maloney JR, Charters AC (1982) Prognosis and management of victims of near-drowning. Trauma 22: 544–549
Auerbach PS, Yajko DM, Nassos PS, Kizer KW, McCosker JE, Geehr EC, Hadley WK (1987) Bacteriology of the marine environment: implications for clinical therapy. Ann Emerg Med 16: 643–649
Auerbach PS, Yajko DM, Nassos PS, Kizer KW, Morris JA, Hadley WK (1987) Bacteriology of the freshwater envoronment: implications for clinical therapy. Ann Emerg Med 16: 1016–1022.
Sims JK, Enomoto PI, Frankel RI, Wong LMF (1983) Marine bacteria complicating seawater near-drowning and marine wounds: a hypothesis. Ann Emerg Med 12: 212–216
Rosenthal SL, Zuger JH, Apollo E (1975) Respiratory colonization withPseudomonas putrefaciens after neardrowning in salt water. Am J Clin Pathol 64: 382–384
Vernon DD, Banner W Jr, Cantwell GP, Holzman BH, Bolte RG, Dean JM (1990)Streptococcus pneumoniae bacteremia associated with near-drowning. Crit Care Med 18: 1175–1176
Kelly MT, Avery DM (1980) LactosepositiveVibrio in seawater, a cause of pneumonia and septicemia in a drowning victim. J Clin Microbiol 11: 278–280
Wenger JD, Hollis DG, Weaver RE, Baker CN, Brown GR, Brenner DJ, Broome CV (1989) Infection caused byFrancisella philomiragia (formerlyYersinia philomiratia). A newly recognized human pathogen. Ann Intern Med 110: 888–892
Fisher JF, Shadowy S, Teabeaut JR, Woodward Y, Michaelis GE, Newman ME, et al. (1982) Near drowning complicated by brain abscess due toLetrillidum boydii. Arch Neurol 39: 511–513
Vieira DF, Van Saene HKF, Miranda DR (1984) Invasive pulmonary asperigillosis after near-drowning. Intensive Care Med 10: 203–204
Kershaw P, Freeman R, Templeton D, DeGirolami PC, DeGirolami U, Tarsy D, et al. (1990)Pseudallescheria boydii infection of the central nervous system. Arch Neurol 47: 468–472
Dworzack DL, Clark RB, Borkowski WJ Smith DL, Dykstra M, Pugsley MP, et al. (1989)Pseudallescheria boydii brain abscess: association with near-drowning and efficacy of high dose, prolonged miconazole therapy in patients with multiple abscesses. Medicine 68: 218–214
McGowan JE, Del Rio C (1990) Other gram-negative bacilli. In: Mandell GL, Douglas RG, Bennett JE (eds) Principles and practicve of infectious diseases, 3rd edn. Churchill Livingstone, New York, 1783–1784
Reuler JB (1978) Hypothermia: pathophysiology, clinical settings, and management. Ann Intern Med 89: 519–527
Nichter MA, Evett PB (1989) Childhood near-drowning: is cardiopulmonary resuscitation always indicated? Crit Care Med 17: 993–995
Biggart MJ, Bohn DJ (1990) Effect of hypothermia and cardiac arrest on outcome of near-drowning accidents in children. J Pediatr 117: 179–183
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13: 818–829
About this article
Cite this article
van Berkel, M., Bierens, J.J.L.M., Lie, R.L.K. et al. Pulmonary oedema, pneumonia and mortality in submersion victims; a retrospective study in 125 patients. Intensive Care Med 22, 101–107 (1996). https://doi.org/10.1007/BF01720715
- Near drowning
- Pulmonary oedema
- Artificial respiration