Near-drowning in Pediatric Respiratory Intensive Care Unit, Siriraj Hospital

Abstract

Objectives: To study characteristics, treatment and outcome of near-drowning patients in Pediatric Respiratory Care Unit (P-RCU), Siriraj Hospital Material and Method: We retrospectively reviewed hospital records of 31 near-drowning patients admitted at P-RCU Siriraj Hospital during 1990-2002. Results: The average age of admitted patients was 4 years (ranged from 6 months to 13 years). Seventy percent of the patients were under 5 years of age. Male: female ratio was 2.1:1. Sixty-two percents of the patients were left alone when near-drowning occurred. The sites of occurrence were around their houses in 60% of cases. Bystander resuscitation was documented in 35%. Common complications were pneumonia (74.2%) and seizure (58%). Patients with poor outcome were children without spontaneous purposeful movement within 24 hours after submersion. Neurological sequelae was found in 35.5% of the cases and the mortality rate was 25.8% (3 due to severe pneumonia from prolonged intubation and aspiration, 2 due to severe brain hypoxia, 2 due to severe adult respiratory distress syndrome (ARDS) and 1 due to intracerebral hemorrhage) Conclusion: Due to poor outcome observed in this study, prevention of submersion injury is the most important and cost-effective measure. However, if near-drowning happens, effective immediate resuscitation is crucial for the best outcome.