RESULTS
There were 27 patients during the study period and, of them, 25 were
enrolled. The median age was 6.7 years (IQR: 4.1-11.8). Of the patients,
18 (72.0%) were male. Seventeen (68.0%) drownings occurred in
saltwater and 8 (32.0%) in freshwater. The initial GCS score was 15 for
14 (56.0%) patients, 14 for 6 (24.0%) patients, 13 for 3 (12.0%)
patients, and 12 for 2 (8.0%) patients. According to the Szpilman
classification, 13 (52.0%) patients were evaluated as grade 3 and 12
(48.0%) as grade 4. Four patients (16.0%) received CPR at any time
between rescue from the scene and the hospital, the duration ranging
between 1.5 and 5 minutes. The clinical and laboratory findings of the
patients are summarized in Table 1. The chest X-rays of all patients
revealed acute pulmonary edema. Treatment with 10-12 L/min oxygen by a
non-rebreather face mask with a reservoir was administered for all
children during the time interval between arrival to the pediatric
emergency department and the start of NIV application.
All patients received BiPAP therapy in ST mode using oronasal or
full-face masks, inspiratory positive airway pressure (IPAP) in the
range of 8-18 cmH₂O, and expiratory positive airway pressure (EPAP) in
the range of 4-10 cmH₂O. For 13 (52.0%) patients, BiPAP therapy was
started in the first hour, while for 12 (48.0%) it was started between
1 and 4 hours after arrival to the pediatric emergency department. A
significant increase in S/F ratios was observed from the beginning of
NIV treatment and this increase was also observed for the 2nd, 4th, 8th,
and 12th hours (p <0.05) (Figure 1). A significant
increase in SpO₂ values was also observed from the start of NIV use and
the same increase was observed for the 2nd and 4th hours
(p <0.05) (Figure 2). There was a decrease in RR at the
4th hour of NIV treatment (p <0.05) (Figure 3). The
median length of NIV use was 7.0 hours (IQR: 5.2-12.5). No side effects
were observed during NIV treatment. Of all NIV applications, no patient
subsequently deteriorated to IMV.
Of the 25 patients, 10 (40.0%) were admitted to the PICU, and 15
(60.0%) of them were observed in the pediatric emergency department and
then discharged. All patients who were admitted to the PICU had Szpilman
scores of grade 4. Of the 15 patients who were discharged from the
emergency department, 13 (86.6%) of them had a Szpilman score of grade
3 and 2 (13.4%) had a score of grade 4; children who were admitted to
the PICU had higher Szpilman scores (p <0.001). The mean
duration of NIV treatment was also longer in children who were admitted
to the PICU (admitted: 13.4±4.8 hours, not admitted: 6.1±2.6 hours;p <0.001). There was no difference in PICU admission
rates, duration of NIV treatment, or length of stay in the PICU or the
hospital for drownings that occurred in fresh versus saltwater. The mean
length of stay in the PICU was 19.3±3.0 hours and the median length of
stay in the hospital was 28.0 hours (IQR: 20.0-53.0).