Early application of non-invasive ventilation for children with
pulmonary edema after drowning
Abstract
Background: The present study aimed to assess the efficacy of
non-invasive ventilation (NIV) on the clinical course, oxygenation, need
for invasive mechanical ventilation (IMV), and outcomes for children
with pulmonary edema after drowning. Methods: We conducted a
retrospective chart review. Children who were referred to the pediatric
emergency department due to drowning-related pulmonary edema and
underwent NIV between May 2014 and October 2020 were included.
Demographics, vital signs, clinical findings, and results of laboratory
and radiologic investigations were recorded. Patients were divided into
6 groups using the Szpilman classification system. The need for IMV, the
need for pediatric intensive care unit (PICU) admission, and the length
of NIV treatment and stay in the PICU were recorded for each patient.
Results: Twenty-five patients were enrolled. According to the Szpilman
classification, 13 (52.0%) patients were evaluated as grade 3 and 12
(48.0%) as grade 4. All patients were treated with bi-level positive
airway pressure in the spontaneous/timed mode. A significant increase in
oxygen saturation (SpO₂) and SpO₂/fraction of inspired oxygen ratios was
observed from the beginning of NIV treatment and this increase was also
observed for the 2nd and 4th hours. There was a decrease in respiratory
rate at the 4th hour of NIV treatment. No patient subsequently
deteriorated to IMV. Conclusion: We have reported a favorable clinical
course of drowning patients who underwent early use of NIV in the
pediatric emergency department. Management of drowning patients with
pulmonary edema by NIV with close follow-up can be successfully applied
in selected cases.