What factors should be monitored before discharging drowning patients?

Updated: Jun 19, 2019
  • Author: G Patricia Cantwell, MD, FCCM; Chief Editor: Joe Alcock, MD, MS  more...
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Meticulously monitor for evidence of ARDS; multiple organ system failure; nosocomial infection, especially pneumonia; hyperglycemia [106] ; and/or gastric stress ulceration. Management of ARDS due to submersion is similar to that of ARDS from other causes.

The extent of invasive monitoring needed (eg, arterial catheter, pulmonary artery catheter, central venous pressure catheter) is determined by the degree of hemodynamic or respiratory instability and the presence of renal failure.

Invasive monitoring of intracranial pressure has been suggested in both human and animal studies to be neither useful nor necessary. However, no large, well-controlled clinical trials specific to drowning have addressed intracranial pressure monitoring, electrophysiological monitoring, tissue oxygenation management, specific pharmacologic management, vigorous glucose control, and temperature management on neurologic outcome. [75, 80]

Watch for evidence of pneumonia and CNS infection. Uncommon infections may present late and unusually. Prophylactic antimicrobial therapy has not proven beneficial.

Monitor closely for bacterial and fungal infection. Evidence is insufficient to support the use of prophylactic antibiotics.

Begin aggressive rehabilitation early (as soon as tolerated) to prevent disuse injury and promote functional improvement.

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