Near-Drowning: Clinical Course of Lung Injury in Adults

Gregorakos, Leonidas; Μάρκου, Νικόλαος; Psalida, Vasiliki; Kanakaki, Maria; Alexopoulou, Anastasia; Sotiriou, Eva; Damianos, Anastasios; Myrianthefs, Pavlos

doi:10.1007/s00408-008-9132-4

Cited by 78 publications

(58 citation statements)

References 25 publications

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“…We did exclude conditions that may lead to aspiration and ARDS development such as inhalational injuries, burns, and drownings 38,39 . We also excluded patients with isolated and serious TBI so we may address the effects of BAC on ARDS risk without entirely separate TBI effects.…”

Section: Discussionmentioning

confidence: 99%

Blood alcohol content, injury severity, and adult respiratory distress syndrome

Afshar

Smith

Terrin

et al. 2014

Journal of Trauma and Acute Care Surgery

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Background Elevated blood alcohol content is a risk factor for injury. Associations of blood alcohol content with acute respiratory distress syndrome have not been conclusively established. We evaluated the association of a BAC >0 mg/dL with the intermediate outcomes, Injury Severity Score and Glasgow Coma Score, and their association with acute respiratory distress syndrome development. Methods Observational retrospective cohort study of 26,305 primary trauma admissions to a statewide referral trauma center from July 11, 2003 to October 31, 2011. Logistic regression was performed to assess the relationship between Admission blood alcohol content, Injury Severity Score, Glasgow Coma Score, and acute respiratory distress syndrome development within five days of admission. Results The case-rate for acute respiratory distress syndrome was 5.5% (1447). Blood alcohol content >0 mg/dL was associated with acute respiratory distress syndrome development in adjusted analysis (Odds Ratio 1.50; 95% Confidence Interval 1.33–1.71, p<0.001). High Injury Severity Score (≥16) had a stronger association with acute respiratory distress syndrome development (Odds Ratio 17.99; 95% Confidence Interval 15.51–20.86); as did low Glasgow Coma Score (≤8) (Odds Ratio 8.77; 95% Confidence Interval 7.64–10.07, p<0.001). Patients with low Glasgow Coma Score and high Injury Severity Score had the most frequent acute respiratory distress syndrome (33.6%) and the highest case fatality rate without acute respiratory distress syndrome (24.7%). Conclusions Elevated blood alcohol content is associated with acute respiratory distress syndrome development. In the analysis of alcohol exposure, Injury Severity Score and Glasgow Coma Score occur after alcohol ingestion, making them intermediate outcomes. Injury Severity Score and Glasgow Coma Score were strong predictors of acute respiratory distress syndrome and may be useful to identify at-risk patients. Elevated blood alcohol content may increase the frequency of the acute respiratory distress syndrome through influence on injury severity or independent molecular mechanisms which can be discriminated only in experimental models

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Section: Discussionmentioning

confidence: 99%

Blood alcohol content, injury severity, and adult respiratory distress syndrome

Afshar

Smith

Terrin

et al. 2014

Journal of Trauma and Acute Care Surgery

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“…[20] It is difficult to differentiate between the stress response of drowning and true infectious aetiology based on early imaging and laboratory testing, and even bedside diagnostics may be insensitive. Antibiotics may be considered with persistently high fever and increased sputum production.…”

Section: Emergency Department Managementmentioning

confidence: 99%

Update on drowning

Matthew

Robertson²,

Hofmeyr

2017

S Afr Med J

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An 18-year-old matriculant goes to the beach with friends to celebrate his school results. The ensuing boisterous party includes consumption of alcohol. As dusk falls, he goes for a swim with his girlfriend. She is soon seen waving frantically to their friends back on the beach. He has disappeared below the water surface. Their friends swim out, and after 10 minutes they manage to find him, and bring him to shore. They immediately start cardiopulmonary resuscitation (CPR), while calling for help. BackgroundDespite being essential to life, water, which comprises >60% of our body mass and covers >75% of the surface our planet, continues to be an occupational and recreational threat to humans. Drowning among young adults in South Africa (SA) is unfortunately especially common. Poor swimming ability due to historical lack of access to facilities, concomitant alcohol use and easy access to rivers, lakes and the ocean are all contributing factors. This is compounded by relatively limited resources to respond to drowning incidents across wide, unpatrolled areas, resulting in a growing burden of disease affecting the younger population groups in SA. Recognition of a drowning event is also a problem, as not every drowning victim will indicate their need for assistance (Fig. 1). This review examines the evidence and recommendations on drowning from an African perspective, and brings the health fraternity one step closer to developing guidelines for our country. DefinitionDrowning is defined as the process of experiencing respiratory impairment from either submersion or immersion in liquid. [1] Drowning outcomes are classified as either drowning with mortality, drowning with morbidity, or drowning without morbidity.[1] Other older terms (such as wet, dry or near drowning) have been deemed unhelpful, and have been abandoned. EpidemiologyDrowning epidemiology varies dramatically worldwide, but is notably more severe in low-to middle-income countries. US data report ~4 000 drowning deaths, 8 000 hospitalisations and 31 000 emer gency department (ED) visits per year for children ˂19 years old.[2] Regret tably, there are no consistent published data for SA, but preliminary information from Lifesaving South Africa (LSA) reveals similar trends in age demographics, although true numbers are largely unknown. [3] Extrapolation from forensic pathology data in the Western Cape provides an estimation of 4/100 000 fatal drownings per year, which is similar to the World Health Organization's estimations for low-income countries in Africa. Despite only an estimated 1 in 4 cases being reported, Africa has the highest rate of drowning in the world. [4] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Drowning is defined as the process of experiencing respiratory impairment from either submersion or immersion in liquid. Drowning morbidity and mortality are an under-recognised public health burden in southern Africa. Continuous concerted efforts are underway to improve awareness among recreational water use...

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“…Lungenschaden. Ertrinkungsopfer haben ein hohes Risiko, nach Submersion ein akutes Lungenversagen zu entwickeln ("acute respiratory distress syndrome", ARDS; [219]). Wenngleich keine randomisierten kontrollierten Studien in dieser speziellen Patientenpopulation durchgeführt wurden, scheint es doch vernünftig, Behandlungsstrategien wie die protektive Beatmung zu berücksichtigen, die bei Patienten mit ARDS eine verbesserte Über-lebensquote demonstriert haben [220].…”

Section: Benzodiazepineunclassified