Respiratory distress syndrome caused by near- or secondary drowning and treatment by positive end-expiratory pressure ventilation
Eggink, W.F.; Bruining, H.A.
Netherlands Journal of Medicine 20(4-5): 162-167
1977
ISSN/ISBN: 0300-2977 PMID: 337174 Document Number: 122467
Between Oct. 1972 and May 1976, 11 patients with near- or secondary drowning were treated. In 9 cases treatment consisted, apart from antibiotics and circulatory support, of positive end-expirator pressure ventilation (PEEP). All patients were ventilated on a volume-cycled respirator with a positive end-expiratory pressure of 10-15 cm H2O. They were sedated and given relaxants during this period. Two patients could be managed without artificial respiration. Pulmonary edema can develop insidiously, and it is often difficult to estimate the degree of edema existing. Especially in hypothermic patients the severity of hypoxia is often misjudged. No differences were found in pulmonary changes which could be related to fresh or salt water as causative factors. Tracheal intubation itself seems to be crucial in the treatment schedule. The profuse edema production hampers the view on the larynx. Suctioning of the trachea is contra-indicated because of the negative pressure effect, which enhances the edema. Blood gas values became normal within 1 h of initiation PEEP ventilation. PEEP ventilation should never be discontinued during the edemic phase. Radiological evidence of edema disappeared within 24 h of near- or secondary drowning in all patients. PEEP ventilation was discontinued after 35 h, and extubation within the next 12 h. The degree of contamination of the aspirated water was the single most important determinant of the final outcome in these cases. In no case was death caused by hypoxia.