From the Guidelines
Near drowning is a direct cause of ARDS (Acute Respiratory Distress Syndrome), and its management should follow standard general recommendations for the treatment of ARDS, as there is no specific evidence to support alternative approaches in the drowning setting 1. The pathophysiology of near drowning-induced ARDS involves the inhalation of water, which damages the lung tissue and disrupts the surfactant layer, leading to alveolar collapse and impaired gas exchange. This process triggers an inflammatory response, causing increased capillary permeability and fluid leakage into the alveolar spaces, resulting in pulmonary edema and hypoxemia. Some key points to consider in the management of near drowning-induced ARDS include:
- Mechanical ventilation with lung-protective strategies, such as low tidal volumes (4-6 mL/kg ideal body weight) and positive end-expiratory pressure (PEEP) to maintain alveolar recruitment 1.
- Management of fluid balance to prevent excessive fluid overload and worsening of pulmonary edema.
- Antibiotic therapy may be necessary if infection develops, particularly after aspiration of contaminated water. The lack of specific evidence on the treatment of ARDS after near drowning supports the use of standard ARDS management guidelines, as recommended by the 2021 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1.
From the Research
Near Drowning and ARDS
- Near drowning can lead to acute respiratory distress syndrome (ARDS) due to aspiration of water and particulate matter, causing direct alteration of the alveolar membrane and volume overloading 2.
- The clinical manifestations of near-drowning include respiratory involvement, with most patients developing hypoxemia and some progressing to ARDS or acute lung injury 3.
- The development of ARDS after near-drowning is characterized by interstitial pulmonary edema, hypoxemia, hypercapnia, and acidosis, requiring mechanical ventilation and other supportive therapies 2, 4.
Pathophysiology of ARDS
- ARDS is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability, causing alveolar flooding and deep hypoxemia 5.
- The hallmark of ARDS is pulmonary infiltrates on chest X-ray and CT, together with decreased lung compliance, and it always occurs within a week of exposure to a precipitating factor, such as pneumonia, shock, or aspiration of gastric contents 5.
Treatment of ARDS
- The cornerstone of therapy for ARDS lies in the treatment of the underlying cause and the use of mechanical ventilation, which should be administered with a protective strategy to avoid ventilator-induced lung injury 6, 5.
- The use of positive end-expiratory pressure (PEEP), recruitment maneuvers, and other adjuvants of mechanical ventilation may be necessary to treat hypoxemia, and early prone positioning has been associated with increased survival in severely hypoxemic patients 6, 5.