When is inpatient care indicated for drowning patients?

Updated: Jun 19, 2019
  • Author: G Patricia Cantwell, MD, FCCM; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Certain patients may display mild to moderately severe hypoxemia that is corrected easily with supplemental oxygen. Admit these patients to the hospital for observation. They can be discharged after resolution of hypoxemia if they have no further complications.

Between 90% and 100% of individuals who arrive in the ED with blunted mental status have been shown to survive without neurologic deficit. However, individuals who were comatose upon arrival in the ED had significantly poorer outcomes. Approximately 34% died after presentation, and an additional 10-23% survived with severe neurologic residua. [104, 105]

Admit patients who require intubation and mechanical ventilation to the ICU. Varying degrees of neurologic as well as pulmonary insults typically complicate their courses. Pulmonary hypertension may result from the release of inflammatory mediators, increasing right ventricular afterload, and decreasing left ventricular preload and pulmonary perfusion. Newer ventilatory modes, including airway pressure release ventilation and high frequency oscillatory ventilation can decrease the risk of ventilator-associated lung injury (VALI). The general ventilator management strategy strives to limit peak pressures to 25 torr, tidal volumes 6-8 mL/kg, fraction of inspired oxygen <0.6, and optimizing PEEP to improve oxygenation. Use of permissive hypercapnia to decrease barotrauma in many patients with ARDS may not be appropriate in this setting of hypoxic ischemic CNS injury. The elevation in PCO2 may adversely affect intracranial pressure. High levels of PEEP may be transmitted to the intracranial space and further increase intracranial pressure and additionally decrease cerebral venous return.


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