Drowning Patients..Part2..In ICU

Taking care of Drowning patient in ICU

• Treat drowning victims as ARDS patients, with low tidal-volume lung-protective mechanical ventilation.
• Not weaning mechanical ventilation for at least 24 hours, even if a drowning victim appears ready to extubate: the underlying pulmonary injury may result in recurrence of pulmonary edema, reintubation and increased risk of complications.
• Pneumonia is usually not present initially (12% in one series) and authors believe antibiotics may be over-prescribed and sometimes harmful; instead, use clinical evidence of infection or bronchoscopic / mini-BAL sampling to identify pneumonia and need for antibiotics. Swimming pool water in particular is unlikely to cause pneumonia.
• On the other hand, late-onset nosocomial pneumonias (i.e., ventilator-associated pneumonia) may be equally common among mechanically ventilated drowning victims as those with other causes of respiratory failure.
• Systemic inflammatory response syndrome (SIRS) can occur after drowning — authors advise not to “misinterpret [it] as infection,” but also say that sepsis is possible, too (not helpful).
• Expect a faster respiratory recovery than in typical ARDS patients, with full recovery of pulmonary function in most cases.