Chest
Volume 70, Issue 2, August 1976, Pages 231-238
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Clinical Investigations
Clinical Course of 91 Consecutive Near-Drowning Victims

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Hospital records of 91 consecutive near-drowning victims were studied retrospectively. Eighty-one (89 percent) of these patients survived. Patients who were alert on arrival at the emergency room survived, but those who were comatose and had fixed dilated pupils died. Other states of consciousness were unreliable predictors of survival. All patients with a normal chest roentgenogram on admission survived; however, values for arterial oxygen tension (PaO2) did not necessarily correlate with the chest roentgenograms. Values for arterial blood gas tensions and pH varied widely, as follows: PaO2, 25 to 465 mm Hg; arterial carbon dioxide tension (PaCO2), 17 to 100 mm Hg; pH, 6.77 to 7.50; and arterial bicarbonate level, 6.6 to 29.7 mEq/L. The ratio of PaO2 to the fractional concentration of oxygen in the inspired gas (FIo2), which was calculated to standardize PaO2 data for varying concentrations of inspired oxygen, ranged from 30 to 585 mm Hg. Only one patient with a ratio of PaO2/FIo2 greater than 150 mm Hg on admission subsequently died; this was a neurologic rather than a pulmonary death. Serum electrolytic concentrations and values for hemoglobin level and hematocrit reading neither predicted survival nor indicated that a threat to life existed. Steroid and prophylactic antibiotic therapy did not appear to increase the chance of survival. Observations on these patients are discussed in light of previous experiments in animals, and an approach to therapy is suggested.

Section snippets

RESULTS

The charts of 70 male and 21 female patients were studied. Sixty-one patients suffered near-drowning in fresh water, 27 in sea water, and three in brackish water. Eighty-one patients (89 percent) survived, seven died after aspirating fresh water, and three died after aspirating sea water. The average age of the survivors was 19 years (range, 1 to 79 years). The average age of those who died was 16 years (range, 1 to 56 years).

DISCUSSION

Retrospective studies have inherent problems because the extent of disease is not constant, nor are measurements and therapy uniform. Animal studies have shown that the pathophysiologic changes which occur are related to both the type and volume of water aspirated.1, 2, 3, 13 Since human near-drowning victims aspirate variable quantities and types of fluid, the resulting pathophysiologic changes are variable. In spite of these limitations, a number of points in this series are worth considering.

ACKNOWLEDGMENTS

We wish to thank Thorkild W. Andersen, M.D., and Edwin S. Munson, M.D., for their advice; and Joan Beer, Rose Ray, Ph.D., and Pauline Snider for their assistance in preparing the manuscript.

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    Manuscript received September 22; revision accepted February 20.

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