Outcome of children with near drowning requiring treatment in PICU

A number of near drowned children needed admission to a PICU due to the severity of their condition. The aim of this review is to illustrate the epidemiology, the clinical features, the management and the outcome of near drowned children admitted to our PICU. For this purpose, we reviewed the charts of near drowned children admitted to our unit during the last 11 years. The study population consisted of 11 children (7 boys and 4 girls) aged 2.5–12.5 years (mean age 7.2 years, SD4,1, SE1.3). At the same period a five-fold number of near drowned children were hospitalized in pediatric wards. The submersion site, among our patients, was sea in 6 cases, a swimming pool in 3, a pond in 2 cases. Ten children were transferred from district hospitals where they had initially received advanced life support. 6/10 children were transferred intubated. 4/10 children were in cardiac arrest after the accident, 3/4 had been given basic life support at the accident site and subsequently 2 of them were intubated on their arrival at the nearest district hospital. 1/4 was intubated in the nearest hospital where he was transferred with brain death without having received appropriate basic life support for about 30 min. 2/3 children who initially were apnoeic and comatose, required intubation. The remaining 4 children had respiratory distress and irregular respiration but only one needed intubation. 8/11 patients have clinical and roentgenographic features of pulmonary oedema. The intubated children remained on mechanical ventilation from 12–36 h. Convulsions occurred in 3 children. In 1/11 patients there were signs of high intracranial pressure with good response to mannitol administration. 10/11 patients survived and discharged from hospital after 3–6 days of hospitalization overall. The patient who was admitted with brain death, never recovered. All survived children had no neurological sequalae on their follow up 2–5 years later. Our results emphasize that even the most severe cases of near drowning have a favorable outcome, provided that the victims are given basic life support at the accident site.