J Korean Soc Traumatol.  2019 Sep;32(3):136-142. 10.20408/jti.2019.013.

The Utility of Non-Invasive Nasal Positive Pressure Ventilation for Acute Respiratory Distress Syndrome in Near Drowning Patients

• Kim JH
• Sun KH
• Park YJ

• KMID: 2462951
• DOI: http://doi.org/10.20408/jti.2019.013

Abstract

PURPOSE
Near drowning refers to immediate survival after asphyxia due to submersion or immersion in water, which is a crucial public safety problem worldwide. Acute lung injury or acute respiratory distress syndrome (ARDS) is a common complication of near drowning. The purpose of this study was to investigate the feasibility and effectiveness of noninvasive nasal positive pressure ventilation (NINPPV).
METHODS
This retrospective study was conducted at a tertiary emergency department. NINPPV was administered for moderate ARDS caused by submersion or immersion in patients who were older than 18 years, from January 2015 to December 2018. We collected the demographic (age, sex, length of hospital stay, and outcome), laboratory (arterial blood gas, lactate, oxygen saturation, partial pressure of oxygen divided by the fraction of inspired oxygen, complete blood count, blood urea nitrogen, and creatinine), and clinical data (acute lung injury index and ventilator failure) of the patients. A statistical analysis was performed using Statistical Package for the Social Sciences version 20.0 for Windows.
RESULTS
NINPPV treatment was provided to 57 patients for near drowning, 45 of whom (78.9%) were successfully treated without complications; in 12 (21.1%), treatment was changed to invasive mechanical ventilation within 48 hours due to ARDS or acute kidney injury. NINPPV treatment was successful in 31 (75.6%) out of 41 sea-water near drowning patients. They were more difficult to treat with NINPPV compared with the fresh-water near drowning patients (p<0.05).
CONCLUSIONS
NINPPV would be useful and feasible as the initial treatment of moderate ARDS caused by near drowning.

Keyword

Near drowning; Noninvasive ventilation; Respiratory distress syndrome, adult

MeSH Terms

Acute Kidney Injury
Acute Lung Injury
Asphyxia
Blood Cell Count
Blood Urea Nitrogen
Emergency Service, Hospital
Humans
Immersion
Lactic Acid
Length of Stay
Lung Injury
Near Drowning*
Noninvasive Ventilation
Oxygen
Partial Pressure
Positive-Pressure Respiration*
Respiration, Artificial
Respiratory Distress Syndrome, Adult*
Retrospective Studies
Social Sciences
Ventilators, Mechanical
Water
Lactic Acid
Oxygen
Water