Abstract
BackgroundDrowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. This systematic review addressed the following question: In drowning patients with lung injury, what is the evidence from primary studies regarding treatment strategies and subsequent patient outcomes?MethodsThe search strategy utilised PRISMA guidelines. Databases searched were MEDLINE, EMBASE, CINAHL, Web of Science and SCOPUS. There were no restrictions on publication date or age of participants. Quality of evidence was evaluated using GRADE methodology.ResultsForty-one papers were included. The quality of evidence was very low. Seventeen papers addressed the lung injury of drowning in their research question and 24 had less specific research questions, however included relevant outcome data. There were 21 studies regarding extra-corporeal life support, 14 papers covering the theme of ventilation strategies, 14 addressed antibiotic use, seven papers addressed steroid use and five studies investigating diuretic use. There were no clinical trials. One retrospective comparison of therapeutic strategies was found. There was insufficient evidence to make recommendations as to best practice when supplemental oxygen alone is insufficient. Mechanical ventilation is associated with barotrauma in drowning patients, but the evidence predates the practice of lung protective ventilation. There was insufficient evidence to make recommendations regarding adjuvant therapies.ConclusionsTreating the lung injury of drowning has a limited evidentiary basis. There is an urgent need for comparative studies of therapeutic strategies in drowning.
Highlights
Drowning is a cause of significant global mortality
The aim of this paper is to review the existing evidence to guide the clinician in the treatment of the lung injury and respiratory distress associated with drowning
Patient demographics were incomplete with regards to gender in eleven papers [19, 20, 25,26,27, 31,32,33,34,35]
Summary
Drowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. Drowning is a major cause of preventable death and morbidity worldwide. There are over 295,000 unintentional drowning deaths (excluding boating) per year [1, 2]. Ninety percent of these deaths occur in middle- and low-income countries, and half the fatalities are aged less than 25 years [1]. The mechanism of drowning involves aspiration of water into the lung which damages surfactant, disrupts the alveolar capillary membrane and leads to the development of alveolar oedema, resulting in a local acute respiratory distress syndrome (ARDS)-like syndrome [6].
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