From the Guidelines
Monitoring for dry drowning should be done by watching for symptoms like persistent coughing, difficulty breathing, extreme fatigue, irritability, or chest pain in the 24 hours following water exposure, especially in children, and seeking immediate medical attention at an emergency room if these symptoms appear. The term "dry drowning" is not medically recognized, but it refers to respiratory problems that develop after water exposure, which can occur when small amounts of water enter the airway, causing inflammation and breathing difficulties 1. According to the 2024 American Heart Association and American Academy of Pediatrics focused update on special circumstances, hypoxia is the major sequela of drowning, and optimizing oxygenation may be beneficial due to decreased diffusion capacity of the lungs from aspiration 1.
The duration and severity of hypoxia sustained as a result of drowning is the single most important determinant of outcome, and prompt initiation of rescue breathing increases the victim’s chance of survival 1. Multiple observational evaluations have demonstrated that decompensation after fresh or salt-water drowning can occur in the first 4 to 6 hours after the event, supporting the transportation of all victims to a medical facility for monitoring for at least 4 to 6 hours if feasible 1.
Key symptoms to monitor for dry drowning include:
- Persistent coughing
- Difficulty breathing
- Extreme fatigue
- Irritability
- Chest pain It is essential to seek immediate medical attention if these symptoms appear, as true drowning emergencies require immediate action to prevent brain damage within minutes. Prevention measures, such as teaching children water safety, ensuring proper supervision during water activities, and learning CPR, are also crucial in reducing the risk of drowning and related complications 1.
From the Research
Monitoring for Dry Drowning
- Dry drowning is a type of drowning where no water enters the trachea, and it responds readily to resuscitation efforts 2
- The current concept of drowning recognizes few differences between saltwater and freshwater aspiration; the therapeutic approach is the same for both types 2
- Hospitalization for observation is necessary in every instance, as adult respiratory distress syndrome may develop and cause secondary drowning 2
- Patients with minimal or no symptoms do not require any specific diagnostic workup, aside from physical examination and 4 to 6 hours of observation prior to discharge 3
- Patients with more severe symptoms may present with rales and foamy secretions, and should be managed with high-concentration oxygen and positive airway pressure 3
Pathophysiology and Therapy
- Drowning involves some physiological principles and medical interventions that are unique, and it occurs in a deceptively hostile environment that involves an underestimation of the dangers or an overestimation of water competency 4
- The acute lung injury alters the exchange of oxygen in different proportions, and the combined effects of fluid in the lungs, loss of surfactant, and increased capillary-alveolar permeability result in decreased lung compliance, increased right-to-left shunting in the lungs, atelectasis, and alveolitis, a noncardiogenic pulmonary edema 4
- The most serious pathophysiologic consequence of near-drowning is hypoxemia, which usually is due to aspiration-induced noncardiogenic edema 5
Observation and Treatment
- Although completely asymptomatic patients with normal vital signs, oxygenation and chest radiographs require only 4 to 6 hours of observation, many near-drowning victims will require at least 24 hours of observation 5
- Ventilation therapy should achieve an intrapulmonary shunt ≤ 20% or Pao2:Fio2 ≥ 250, and premature ventilatory weaning may cause the return of pulmonary edema with the need for re-intubation and an anticipation of prolonged hospital stays and further morbidity 4