From the Guidelines
Chest tubes are not a standard part of the treatment for drowning, and their use is only indicated in specific complications such as pneumothorax or significant pleural effusions. The primary focus in drowning management is addressing hypoxemia through airway management, oxygenation, and ventilation, as emphasized by the 2024 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. Treatment usually involves supplemental oxygen, positive pressure ventilation if needed, and addressing any respiratory distress or failure.
Key aspects of drowning management include:
- Rescue breathing as soon as possible to improve outcomes in cardiac arrest following drowning 1
- Addressing respiratory support, correction of acid-base and electrolyte abnormalities, temperature management, and any secondary complications like pneumonia or acute respiratory distress syndrome
- The use of chest tubes is guided by the management of specific complications, such as pneumothorax, where the size of the chest tube and the use of suction or a water seal device depend on the clinical circumstances, as outlined in guidelines for the management of spontaneous pneumothorax 1. However, these complications are uncommon in typical drowning scenarios, and the pathophysiology of drowning primarily involves aspiration of water leading to surfactant dysfunction, alveolar damage, and ventilation-perfusion mismatch, rather than air accumulation in the pleural space that would necessitate chest tube placement.
Therefore, the management of drowning should focus on the initial resuscitative efforts, including rescue breathing and addressing the underlying respiratory and cardiac issues, rather than the routine use of chest tubes, unless specific indications are present.
From the Research
Treatment for Drowning
- The provided studies do not directly address the use of chest tubes as a treatment for drowning 2, 3, 4.
- However, studies suggest that drowning can lead to acute respiratory distress syndrome, which may require mechanical ventilation and other intensive care interventions 2, 3.
- The use of chest tubes is mentioned in the context of treating pneumothorax and other intrathoracic abnormalities, but not specifically for drowning 5, 6.
- One study discusses the insertion of chest drains using an endoscopic trocar-cannula for trauma patients and others, but does not mention drowning as an indication 5.
- Another study provides guidance on managing iatrogenic pneumothorax and chest tubes, but does not address drowning specifically 6.
- A systematic review of treatment strategies for lung injury in drowning patients found insufficient evidence to make recommendations on the use of chest tubes or other interventions 4.