Korean J Crit Care Med.  2001 Nov;16(2):151-155.

Acute Respiratory Distress Syndrome after Severe Hypothermia and Hypotension Due to Near Drowning

• Park HD
• Koo BN
• Han DW
• Han ST
• Koh SO

Abstract

The increase in short-term survival of near-drowning victims after an acute submersion episode has resulted in an increase of major complications. Two major complications are the development of acute respiratory distress syndrome and persistent hypoxic-ischemic central nervous system injury. A 43-year-old male patient was presented with acute respiratory distress syndrome after near drowning. He was severely hypothermic and hypotensive when he arrived to emergency department. His body temperature was 24oC. There was no pulse and no spontaneous respiration. He was treated with advanced life support measure. He was intubated and vasoactive drugs such as epinephrine and norepinephrine were used. On ICU admission, his blood pressure and pulse rate were 80/40 mmHg, 170 beats/min respectively. His oxygen saturation was 40~60% with 100% oxygen. We applied 16~30 cmH2O of PEEP with low tidal volume for recruitment. Patient was flipped over to prone position. Solu-medrol 1.0 g was infused. The blood pressure restored to 140/50 mmHg, and the pulse rate was normalized to 100 beats/min. The dose of vasopressors and inotropes were reduced and stopped 5 hour after the arrival. When the oxygenation has improved, the position was changed to supine and PEEP was lowered. Eventually weaning was successful. Brain MRI and EEG showed global atrophy of cerebral cortex and moderate diffuse brain dysfunction respectively. He received tracheostomy since he was semi-comatose. He was transferred to general ward on 39th ICU day.

Keyword

Acute respiratory distress syndrome; Hypotension; Hypoxic damage of central nervous system; Intensive care; Near drowning; Severe hypothermia

MeSH Terms

Adult
Atrophy
Blood Pressure
Body Temperature
Brain
Central Nervous System
Cerebral Cortex
Electroencephalography
Emergency Service, Hospital
Epinephrine
Heart Rate
Humans
Hypotension*
Hypothermia*
Immersion
Critical Care
Magnetic Resonance Imaging
Male
Methylprednisolone Hemisuccinate
Near Drowning*
Norepinephrine
Oxygen
Patients' Rooms
Prone Position
Respiration
Respiratory Distress Syndrome, Adult*
Tidal Volume
Tracheostomy
Weaning
Epinephrine
Methylprednisolone Hemisuccinate
Norepinephrine
Oxygen