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Cousin VL, Pittet LF. Microbiological features of drowning-associated pneumonia: a systematic review and meta-analysis. Ann Intensive Care 2024; 14:61. [PMID: 38641650 PMCID: PMC11031557 DOI: 10.1186/s13613-024-01287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/02/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Drowning-associated pneumonia (DAP) is frequent in drowned patients, and possibly increases mortality. A better understanding of the microorganisms causing DAP could improve the adequacy of empirical antimicrobial therapy. We aimed to describe the pooled prevalence of DAP, the microorganisms involved, and the impact of DAP on drowned patients. METHODS Systematic review and meta-analysis of studies published between 01/2000 and 07/2023 reporting on DAP occurrence and microorganisms involved. RESULTS Of 309 unique articles screened, 6 were included, involving 688 patients. All were retrospective cohort studies, with a number of patients ranging from 37 to 270. Studies were conducted in Europe (France N = 3 and Netherland N = 1), United States of America (N = 1) and French West Indies (N = 1). Mortality ranged between 18 to 81%. The pooled prevalence of DAP was 39% (95%CI 29-48), similarly following freshwater (pooled prevalence 44%, 95%CI 36-52) or seawater drowning (pooled prevalence 42%, 95%CI 32-53). DAP did not significantly impact mortality (pooled odds ratio 1.43, 95%CI 0.56-3.67) but this estimation was based on two studies only. Respiratory samplings isolated 171 microorganisms, mostly Gram negative (98/171, 57%) and mainly Aeromonas sp. (20/171, 12%). Gram positive microorganisms represented 38/171 (22%) isolates, mainly Staphylococcus aureus (21/171, 12%). Water salinity levels had a limited impact on the distribution of microorganisms, except for Aeromonas sp. who were exclusively found following freshwater drowning (19/106, 18%) and never following seawater drowning (0%) (p = 0.001). No studies reported multidrug-resistant organisms but nearly 30% of the isolated microorganisms were resistant to amoxicillin-clavulanate, the drug that was the most commonly prescribed empirically for DAP. CONCLUSIONS DAP are commonly caused by Gram-negative bacteria, especially Aeromonas sp. which is exclusively isolated following freshwater drowning. Empirical antimicrobial therapy should consider covering them, noting than amoxicillin-clavulanate may be inadequate in about one-third of the cases. The impact of DAP on patients' outcome is still unclear.
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Affiliation(s)
- Vladimir L Cousin
- Intensive Care Unit, Department of Pediatric, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1206, Geneva, Switzerland.
| | - Laure F Pittet
- Infectious Diseases, Immunology and Vaccinology Unit, Department of Pediatric, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
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Jing L, Peng X, Li D, Qin Y, Song Y, Zhu W. Treatment with sivelestat sodium of acute respiratory distress syndrome induced by chemical pneumonitis: A report of three cases. Exp Ther Med 2023; 26:476. [PMID: 37753302 PMCID: PMC10518657 DOI: 10.3892/etm.2023.12175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/27/2023] [Indexed: 09/28/2023] Open
Abstract
Inhalation of acid fumes and aspiration of liquid substances or gastric contents may not initiate dyspnea within several hours after exposure but may result in delayed onset of alveolar edema. The present report presents three cases of inhalation or aspiration of chemical substances that resulted in acute respiratory distress syndrome (ARDS). Due to different underlying reasons, three patients developed ARDS resulting from chemical pneumonitis and pulmonary infection. From patients with dyspnea, dry rales could be heard in both lungs, with <92% percutaneous oxygen saturation at room air. All patients were treated using a high-flow nasal cannula and sivelestat sodium. Oxygenation gradually improved and the patients were discharged without adverse events. These cases suggest that early treatment with sivelestat sodium may improve the clinical outcomes of patients with ARDS.
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Affiliation(s)
- Liang Jing
- Department of Emergency-Critical Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Xi Peng
- Department of Internal Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Dayong Li
- Department of Emergency-Critical Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Yusen Qin
- Department of Emergency-Critical Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Yaqin Song
- Department of Emergency-Critical Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Wei Zhu
- Department of Emergency-Critical Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
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Thom O, Roberts K, Leggat PA, Devine S, Peden AE, Franklin RC. Addressing gaps in our understanding of the drowning patient: a protocol for the retrospective development of an Utstein style database and multicentre collaboration. BMJ Open 2023; 13:e068380. [PMID: 36759033 PMCID: PMC9923278 DOI: 10.1136/bmjopen-2022-068380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION This retrospective observational study aims to create a comprehensive database of the circumstances of drowning (including care provided and outcomes of care) to report against the Utstein style for drowning (USFD) for patients presenting to the emergency department (ED). Four areas will be examined: a feasibility study of the USFD; a comparison of classification and prognostication systems; examination of indications and efficacy of different ventilation strategies; and differences in the circumstances, severity, treatment and outcomes of drowning by sex and gender. METHODS AND ANALYSIS This protocol outlines retrospective data collection for all patients presenting to EDs of the Sunshine Coast Hospital and Health Service in Queensland, Australia with the presenting problem or discharge diagnosis of drowning or immersion between 2015 and 2022. Patients computerised health records (emergency medical service record, pathology, radiology results, medical and nursing notes for ED, inpatient units and intensive care units) will be used to extract data for entry into an USFD database. Descriptive (eg, median, IQR) and inferential statistical analyses (eg, analysis of variance) will be used to answer the separate research questions. Development of an International Drowning Registry using the USFD dataset and the Research Electronic Data Capture (REDCap) web application is discussed. ETHICS AND DISSEMINATION This study has been approved by Metro North Human Research and Ethics Committee (Project No: 49754) and James Cook University Human Research Ethics Committee (H8014). It has been endorsed by national drowning prevention organisations Royal Life Saving Society Australia (RLSSA) and Surf Life Saving Australia (SLSA). Study findings will provide data to better inform clinical management of drowning patients and provide an evidence base on sex and gender differences in drowning. Results will be disseminated through peer review publications, conference presentations and media releases. Results will also be disseminated through RLSSA and SLSA membership of the Australian and New Zealand Resuscitation Council and the Australian Water Safety Council.
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Affiliation(s)
- Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Kym Roberts
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- College of Medicine, Nursing & Health Sciences, University of Galway, Galway, UK
| | - Susan Devine
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Amy E Peden
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
| | - Richard Charles Franklin
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
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Reizine F, Delbove A, Tattevin P, Santos AD, Bodenes L, Bouju P, Fillâtre P, Frérou A, Halley G, Lesieur O, Courouble P, Berteau F, Morin J, Delamaire F, Marnai R, Le Meur A, Aubron C, Reignier J, Gacouin A, Tadié JM. Clinical and microbiological features of drowning-associated pneumonia: a retrospective multicentre cohort study. Clin Microbiol Infect 2023; 29:108.e7-108.e13. [PMID: 35944877 DOI: 10.1016/j.cmi.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Pneumonia is the most frequent infectious complication in patients who have experienced drowning that requires intensive care unit (ICU) admission. We aimed to describe clinical, microbiological, and therapeutic data as well as predictors and impacts of such pneumonia on patients' outcomes. METHODS We conducted a retrospective, multicentre study (2013-2020) of 270 consecutive patients admitted for drowning to 14 ICUs in Western France. Their baseline characteristics and outcomes were compared according to the occurrence of drowning-associated pneumonia (DAP), defined as pneumonia diagnosed within 48 hours of ICU admission. A Cox regression model was used to compare survival on day 28, and logistic regression was used to identify risk factors for DAP. Microbiological characteristics and empirical antibacterial treatment were also analysed. RESULTS Among the 270 patients admitted to the ICU for drowning, 101 (37.4%) and 33 (12.2%) experienced pneumonia and microbiologically proven DAP, respectively. The occurrence of pneumonia was associated with higher severity scores at ICU admission (median Simplified Acute Physiology Score II, 34 [interquartile range {IQR}, 25-55] vs. 45 [IQR, 28-67]; p 0.006) and longer ICU length of stay (2 days [IQR, 1-3] vs. 4 days [IQR, 2-7]; p < 0.001). The 28-day mortality rate was higher among these patients (29/101 [28.7%] vs. 26/169 [15.4%]; p 0.013). Microbiologically proven DAP remained associated with higher 28-day mortality after adjustments for cardiac arrest and water salinity (adjusted hazard ratio, 1.86 [95% CI, 1.06-3.28]; p 0.03). A microbiological analysis of respiratory samples showed a high proportion of gram-negative bacilli (23/56; 41.1%), with a high prevalence of amoxicillin-clavulanate resistance (12/33; 36.4%). CONCLUSIONS Pneumonia is a common complication in patients admitted in the ICU for drowning and is associated with increased mortality.
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Affiliation(s)
- Florian Reizine
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France.
| | - Agathe Delbove
- CH Vannes, Service de Réanimation Polyvalente, Vannes, France
| | - Pierre Tattevin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Alexandre Dos Santos
- CH La Roche sur Yon, Service de Réanimation Polyvalente, La Roche sur Yon, France
| | | | - Pierre Bouju
- CH Lorient, Service de Réanimation Polyvalente, Lorient, France
| | - Pierre Fillâtre
- CH Saint-Brieuc, Service de Réanimation Polyvalente, Saint-Brieuc, France
| | - Aurélien Frérou
- CH Saint Malo, Service de Réanimation Polyvalente, Saint Malo, France
| | | | - Olivier Lesieur
- CH La Rochelle, Service de Réanimation Polyvalente, La Rochelle, France
| | - Patricia Courouble
- CH Saint Nazaire, Service de Réanimation Polyvalente, Saint Nazaire, France
| | - Florian Berteau
- CH Morlaix, Service de Réanimation Polyvalente, Morlaix, France
| | - Jean Morin
- CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Flora Delamaire
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Rémy Marnai
- CH Le Mans, Service de Réanimation Polyvalente, Le Mans, France
| | - Anthony Le Meur
- CH Cholet, Service de Réanimation Polyvalente, Cholet, France
| | - Cécile Aubron
- CHU Brest, Médecine Intensive Réanimation, Brest, France
| | - Jean Reignier
- CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Jean-Marc Tadié
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
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Lu X, Qi W, Wang H, Zheng Z, Jiang L, Xu S. Omadacycline for the treatment of Legionella pneumophila pneumonia caused by drowning: a case report. World J Emerg Med 2023; 14:481-483. [PMID: 37969222 PMCID: PMC10632762 DOI: 10.5847/wjem.j.1920-8642.2023.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/08/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Xiao Lu
- Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wenqi Qi
- Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Haizhen Wang
- Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhongjun Zheng
- Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Libing Jiang
- Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Shanxiang Xu
- Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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杨 楠, 代 继. [Clinical and microbiological characteristics of children with drowning-associated aspiration pneumonia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:417-422. [PMID: 35527418 PMCID: PMC9044991 DOI: 10.7499/j.issn.1008-8830.2110134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the clinical and microbiological characteristics of children with drowning-associated aspiration pneumonia, so as to provide a reference for empirical selection of antibacterial agents. METHODS A retrospective analysis was performed on the medical data of 185 children with drowning-associated aspiration pneumonia who were admitted to Children's Hospital of Chongqing Medical University from January 2010 to October 2020. According to the drowning environment, these children were divided into four groups: fecal group (n=44), freshwater group (n=69), swimming pool group (n=41), and contaminant water group (n=31). The clinical characteristics and pathogen detection results were reviewed and compared among the four groups. RESULTS The 185 children had an age of 4 months to 17 years (median 34 months). Sputum cultures were performed on 157 children, and 103 were tested positive (65.6%), with 87 strains of Gram-negative bacteria (68.5%), 37 strains of Gram-positive bacteria (29.1%), and 3 strains of fungi (2.4%). Gram-negative bacteria were the main pathogen in the fecal group and the contaminant water group, accounting for 88.2% (30/34) and 78.3% (18/23), respectively. The freshwater group had a significantly higher detection rate of Gram-positive bacteria than the fecal group (P<0.008), and the swimming pool group had an equal detection rate of Gram-negative bacteria and Gram-positive bacteria. CONCLUSIONS For pulmonary bacterial infection in children with drowning in feces or contaminant water, antibiotics against Gram-negative bacteria may be applied empirically, while for children with drowning in a swimming pool or freshwater, broad-spectrum antibiotics may be used as initial treatment, and subsequently the application of antibiotics may be adjusted according to the results of the drug sensitivity test.
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Reizine F, Delbove A, Dos Santos A, Bodenes L, Bouju P, Fillâtre P, Frérou A, Halley G, Lesieur O, Jonas M, Berteau F, Morin J, Luque-Paz D, Marnai R, Le Meur A, Aubron C, Reignier J, Tadié JM, Gacouin A. Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:372. [PMID: 34689813 PMCID: PMC8543920 DOI: 10.1186/s13054-021-03792-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
Background Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients’ prognosis remains poorly explored in Intensive Care Units (ICUs) patients. Methods We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model. Results Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03–3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p < 0.0001) and the etiology of drowning appeared more frequently to be a suicide attempt in this population (25.7 vs. 4.2%; p < 0.0001). The other factors independently associated with 28-day mortality were the occurrence of a drowning-related cardiac arrest (aHR 11.5 [95% CI 2.51–52.43], p = 0.0017), duration of cardiopulmonary resuscitation (aHR 1.05 [95% CI 1.03–1.07], p < 0.0001) and SOFA score at day 1 (aHR 1.2 [95% CI 1.11–1.3], p < 0.0001). Conclusions In this large multicenter cohort, freshwater drowning patients had a poorer prognosis than saltwater drowning patients. Reasons for such discrepancies include differences in underlying psychiatric comorbidity, drowning circumstances and severities. Patients with initial cardiac arrest secondary to drowning remain with a very poor prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03792-2.
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Affiliation(s)
- Florian Reizine
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France.
| | - Agathe Delbove
- CH Vannes, Service de Réanimation Polyvalente, 56000, Vannes, France
| | - Alexandre Dos Santos
- CH La Roche Sur Yon, Service de Réanimation Polyvalente, 85191, La Roche sur Yon, France
| | | | - Pierre Bouju
- CH Lorient, Service de Réanimation Polyvalente, 56100, Lorient, France
| | - Pierre Fillâtre
- CH Saint Brieuc, Service de Réanimation Polyvalente, 22000, Saint-Brieuc, France
| | - Aurélien Frérou
- CH Saint Malo, Service de Réanimation Polyvalente, 35400, Saint Malo, France
| | - Guillaume Halley
- CH Quimper, Service de Réanimation Polyvalente, 29000, Quimper, France
| | - Olivier Lesieur
- CH La Rochelle, Service de Réanimation Polyvalente, 17000, La Rochelle, France
| | - Maud Jonas
- CH Saint Nazaire, Service de Réanimation Polyvalente, 44600, Saint Nazaire, France
| | - Florian Berteau
- CH Morlaix, Service de Réanimation Polyvalente, 29600, Morlaix, France
| | - Jean Morin
- CHU Nantes, Médecine Intensive Réanimation, 44000, Nantes, France
| | - David Luque-Paz
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
| | - Rémy Marnai
- CH Le Mans, Service de Réanimation Polyvalente, 72000, Le Mans, France
| | - Anthony Le Meur
- CH Cholet, Service de Réanimation Polyvalente, 49300, Cholet, France
| | - Cécile Aubron
- CHU Brest, Médecine Intensive Réanimation, 29200, Brest, France
| | - Jean Reignier
- CHU Nantes, Médecine Intensive Réanimation, 44000, Nantes, France
| | - Jean-Marc Tadié
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
| | - Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
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Popp LM, Ashburn NP, McGinnis HD, Stopyra JP. Prehospital Cross-Sectional Study of Drowning Patients Across the United States. Wilderness Environ Med 2021; 32:271-277. [PMID: 34183233 PMCID: PMC9052871 DOI: 10.1016/j.wem.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Every year drowning is responsible for 7% of injury-related deaths worldwide, making it the third leading cause of unintentional injury-related death. However, in the United States, little is known regarding the prehospital presentation and management of these patients. The purpose of this study was to describe the drowning population in the United States, with a focus on prehospital time intervals, transport, and cardiac arrest frequency. METHODS A retrospective cross-sectional study was performed querying records from emergency medical services encounters across the United States over 30 mo (January 2016 to July 2018) using the ESO (Austin, TX) national emergency medical services data registry. Patients with a dispatch or chief complaint of drowning were included. Descriptive statistics, binomial proportion tests, and general linear and logistic regression models were used. RESULTS There were 1859 encounters that met the study criteria. Median age was 18 y (n=1855, LQ-UQ 4-46). Pediatric patients accounted for 50% (n=919, 95% CI 47-52). Cardiac arrest occurred in 29% (n=537, 95% CI 27-31), and return of spontaneous circulation occurred in 37% (n=186, 95% CI 32-41). Times were 8±5, 19±17, and 15±10 min (mean±SD) for arrival, on-scene, and transport times, respectively. CONCLUSIONS This national prehospital drowning study demonstrated that despite an 18% fatality rate in drowning encounters, patients were more likely to have return of spontaneous circulation when compared to the overall prehospital national average, with rates higher in pediatric patients. Future studies with outcomes data should focus on identifying factors that improve cardiopulmonary resuscitation success rates.
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Affiliation(s)
- Lucas M Popp
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Nicklaus P Ashburn
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Henderson D McGinnis
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jason P Stopyra
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Thom O, Roberts K, Devine S, Leggat PA, Franklin RC. Treatment of the lung injury of drowning: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:253. [PMID: 34281609 PMCID: PMC8287554 DOI: 10.1186/s13054-021-03687-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/06/2021] [Indexed: 12/05/2022]
Abstract
Background Drowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. This systematic review addressed the following question: In drowning patients with lung injury, what is the evidence from primary studies regarding treatment strategies and subsequent patient outcomes? Methods The search strategy utilised PRISMA guidelines. Databases searched were MEDLINE, EMBASE, CINAHL, Web of Science and SCOPUS. There were no restrictions on publication date or age of participants. Quality of evidence was evaluated using GRADE methodology. Results Forty-one papers were included. The quality of evidence was very low. Seventeen papers addressed the lung injury of drowning in their research question and 24 had less specific research questions, however included relevant outcome data. There were 21 studies regarding extra-corporeal life support, 14 papers covering the theme of ventilation strategies, 14 addressed antibiotic use, seven papers addressed steroid use and five studies investigating diuretic use. There were no clinical trials. One retrospective comparison of therapeutic strategies was found. There was insufficient evidence to make recommendations as to best practice when supplemental oxygen alone is insufficient. Mechanical ventilation is associated with barotrauma in drowning patients, but the evidence predates the practice of lung protective ventilation. There was insufficient evidence to make recommendations regarding adjuvant therapies. Conclusions Treating the lung injury of drowning has a limited evidentiary basis. There is an urgent need for comparative studies of therapeutic strategies in drowning. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03687-2.
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Affiliation(s)
- Ogilvie Thom
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia. .,Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia.
| | - Kym Roberts
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia
| | - Susan Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Richard C Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Royal Life Saving - Australia, National Office, Broadway, Sydney, Australia
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10
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Ryan KM, Dugas J, Pina T, Maksimenko Y, Liu J. Drowning injuries in the United States: Patient characteristics, mortality risk, and associated primary diagnoses. Injury 2020; 51:2560-2564. [PMID: 32798037 DOI: 10.1016/j.injury.2020.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine patient demographics, associated primary diagnoses, mortality risk, and inpatient mortality of admitted drowning patients in the U.S. METHODS Retrospective cross-sectional study using 2016 National Inpatient Sample Healthcare Cost and Utilization Project Agency for Healthcare Research and Quality dataset. External cause codes were used to identify drowning records, excluding self-inflicted/suicides. ICD-10 diagnosis and procedure codes, patient demographics, and admission-related data were collected. RESULTS Of the 4,355 admissions in 2016, 68.3% were male (95% CI 65.3-71.3%) and 70.3% were white (95% CI 66.9-73.6%) with mean length of stay of 5.5 days (95% CI 4.9-6.2) and mean total charge of $81,624 (95% CI $70926-$92321). 8.2% of admissions resulted in inpatient death. Those that died were significantly younger than those that did not die (χ2=5.9, p=0.02). There was a statistically significant association between primary payer and inpatient mortality (χ2=10.5, p=0.02). CONCLUSION Younger, male, and white patients accounted for the majority of drowning admissions and deaths. A significantly larger proportion of Medicaid patients died compared to inpatient mortality of those with other insurance. Recognizing those most impacted by drowning could help better tailor prevention efforts.
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Affiliation(s)
- Kevin M Ryan
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States.
| | - Julianne Dugas
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
| | - Tyler Pina
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
| | - Yevgeniy Maksimenko
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
| | - James Liu
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
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11
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Dakessian A, Bachir R, El Sayed M. Impact of trauma designation levels on survival of drowning victims: An observational study from trauma centers in the United States. Medicine (Baltimore) 2019; 98:e17721. [PMID: 31651907 PMCID: PMC6824668 DOI: 10.1097/md.0000000000017721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Drowning causes significant morbidity and mortality. Healthcare regionalization aims at improving patient outcomes. This study examines the impact of trauma center level designation on survival of drowning victims.Retrospective cohort study utilizing the National Trauma Data Bank (NTDB) 2015. Descriptive, bivariate and multivariate analyses were conducted.The 212 patients were included. Mean age was 33.58 (±20.02) years with 69.3% (n = 147) males. Patients were mostly taken to Level I (n = 107, 50.5%) and II (n = 81, 32.8%) centers, requiring admission (43.5% (n = 96), 23.1% (n = 49) and 8.5% (n = 18) to Intensive Care, floor, and Operating Room, respectively). Overall hospital discharge survival was 83.5% (n = 177). After adjusting for confounders, there was no significant difference in survival of patients taken to Level I compared to Level II and III centers.This study did not identify a survival benefit for patients with drowning related injuries when taken to Level I compared to Level II or III Trauma centers. Further outcome studies are needed in organized trauma systems to improve field triage criteria for specific injury mechanisms.
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Affiliation(s)
- Alik Dakessian
- Department of Emergency Medicine, American University of Beirut Medical Center,
| | - Rana Bachir
- Department of Emergency Medicine, American University of Beirut Medical Center,
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center,
- Emergency Medical Services and Pre-hospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon
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12
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Kim JH, Sun KH, Park YJ. The Utility of Non-Invasive Nasal Positive Pressure Ventilation for Acute Respiratory Distress Syndrome in Near Drowning Patients. JOURNAL OF TRAUMA AND INJURY 2019. [DOI: 10.20408/jti.2019.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- June Hyeong Kim
- Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Kyung Hoon Sun
- Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Yong Jin Park
- Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
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13
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Queiroga AC, Webber J, Schmidt AC, Sempsrott JR, Barcala-Furelos R, Tipton M, Szpilman D. Comment on Cerland, L. et al. Incidence and Consequences of Near-Drowning-Related Pneumonia-A Descriptive Series from Martinique, French West Indies. Int. J. Environ. Res. Public Health 2017, 14, 1402. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040706. [PMID: 29642576 PMCID: PMC5923748 DOI: 10.3390/ijerph15040706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/08/2018] [Accepted: 03/30/2018] [Indexed: 10/26/2022]
Abstract
We read with great interest the recent paper by Cerland et al. on the frequency, nature, and consequences of post-drowning pneumonia[...].
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Affiliation(s)
- Ana Catarina Queiroga
- EPI-Unit, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal.
| | - Jonathon Webber
- Department of Anaesthesiology, The University of Auckland, Auckland 1142, New Zealand.
- Surf Life Saving New Zealand, P.O. Box 39129, Lower Hutt 5045, Wellington 5010, New Zealand.
| | - Andrew C Schmidt
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
- Lifeguards without Borders, P.O. Box 737, Kuna, ID 83634, USA.
| | | | - Roberto Barcala-Furelos
- REMOSS Research Group, Lifesaving and Motor Skill, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain.
| | - Michael Tipton
- Extreme Environments Laboratory, Department of Sport & Exercise Science, University of Portsmouth, Portsmouth PO1 2ER, UK.
| | - David Szpilman
- Sociedade Brasileira de Salvamento Aquático, Barra da Tijuca, Rio de
Janeiro RJ 22631-004, Brazil.
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