CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by CONN, A. W.
Right arrow Articles by BARKER, G. A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by CONN, A. W.
Right arrow Articles by BARKER, G. A.

Canadian Journal of Anesthesia, Vol 25, 259-265, Copyright © 1978 by Canadian Anesthesiologists' Society

Near-Drowning in Cold Fresh Water: Current Treatment Regimen

A. W. CONN M.D., F.R.C.P.(C)1, J. F. EDMONDS M.B., F.R.C.P.(C)1, and G. A. BARKER M.B., F.F.A.R.A.C.S.1

1 Intensive Care Unit, The Hospital for Sick Children, Toronto and the Department of Anaesthesia, University of Toronto, Toronto

Near-drowning victims are admitted to tertiary care facilities within a few hours of submersion. Following initial improvements, many patients undergo progressive cerebral deterioration. A retrospective study (1970-1974) of 30 patients at The Hospital for Sick Children, Toronto, revealed a mortality of 3.3 per cent and permanent brain damage in 30 per cent. At the same time, excellent results were reported, using an aggressive treatment of closed-head injuries, following cold-water water drownings and in the use of profound hypothermia in cardiovascular surgery. In 1975 some specific therapeutic measures were instituted for near-drowning victims and have subsequently been revised and extended.

The goal of treatment is to prevent a significant rise in intracranial pressure while maintaining optimal conditions for cerebral recovery. Therefore therapy is instituted immediately and continued as long as necessary. Treatment is often facilitated by the presence of immersion hypothermia. This regimen includes: (a) severe restriction of hydration; (b) controlled ventilation to obtain high oxygen blood levels and mild hypocarbia (Pacoco2 4 kPa [30 mm Hg]); (c) moderate hypothermia (30° C); (d) control of hyper-excitability by large doses of barbiturate and steriods and (e) control of hyper-rigidity by relax - ants. Monitoring of all body systems is necessary and the continuous monitoring of intracranial pressure is mandatory.

The results during evolution of treatment (1975-1977) in 26 cases showed 15.4 per cent mortality and brain damage in 7.7 per cent. In this limited series, with numerous variables, these results suggest that this therapeutic trial should be continued.

In conclusion, statistical proof to justify these measures is not yet available clinically or experimentally. However, the magnitude of the problem, when associated with the minimal morbidity of treatment, justifies continuation of the program and possible extension to other types of brain injury.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1978 by the Canadian Anesthesiologists' Society.