Affiliation:
1. City Clinical Hospital n.a. V. M. Buyanov
2. Ambulance and Medical Emergency Care Station n.a. A. S. Puchkov
Abstract
Drowning is the third leading cause of unintentional injury death worldwide. The largest number of victims of drowning falls on the young able- bodied population.Objective. There are no recent intensive care protocols for drowning, it is relevant to formulate guidelines for the treatment of drowning. Clinical observation. A 25-year-old female patient was taken by an ambulance team to the intensive care unit with a directional diagnosis ‘drowning in fresh water’ of three degree of severity. The patient had got on ventilator with closed aspiration system. Emergency bronchoscopy was performed during which 200 ml of fluid aspirated into the lungs was removed. Respiratory support was determined by stepwise increase of the PEEP level and decrease in FiO2 level taking into account respiratory index. Given the development of a pro-inflammatory mediator response, lactatacidosis, hemolysis, hyperhydration, a high risk of infectious complications, it was decided to start extracorporeal treatment early by continuous veno-venous hemodiafiltration and de-escalation of systemic antibacterial therapy with meropenem by prolonged infusion. Against the background of the ongoing treatment, we managed to achieve target respiratory parameters and stabilize central hemodynamic parameters by the end of the first day, prevent the development of renal damage, correct water-electrolyte and metabolic disorders, and avoid severe septic complications. Vasopressor support was discontinued on the 4th day, and on the 5th day the patient was switched to independent breathing. The patient`s stay in the intensive care unit was 6 days.Conclusions. Stepwise respiratory therapy using closed suction systems and urgent bronchoscopy prevent direct damage to the alveoli and ongoing translocation of fluid into the vascular bed. Prescribing broad-spectrum antibiotics prior to the growth of clinical and laboratory signs of infectious lung lesions allows to reduce the risk of severe septic complications with pulmonary destruction parenchyma. Early onset extracorporeal treatment by CVVHDF allows to correct homeostasis disorders, eliminate hypervolemia, prevent the development of acute renal damage as a result of hemolysis.
Reference21 articles.
1. Intensive therapy. National Guide. Volume 1. Edited by: Zabolotskikh I. B., Protsenko D. N., M.: GEOTAR-Media. 2020; 498–499.
2. Rakhimaev R. S., Tashsnov D. K., Sedenko V. A., Khairulin R. Z. Incomplete drowning. Bulletin of the Almaty State Institute for Advanced Training of Physicians 2008; No. 1–2 (6–7): 70–75.
3. Yaroshetsky A. I., Gritsan A. I. et al. Diagnosis and intensive therapy of acute respiratory distress syndrome. Clinical recommendations of the Federation of Anesthesiologists and Resuscitators. 2021.
4. Kulabukhov V. V., Chizhov A. G., Kudryavtsev A. N., Kleuzovich A. A., Chaus N. I. Experience in implementing the ‘Isolated patient’ concept in the intensive care unit. Medical Council. 2013 (5–6): 53–58.
5. A. Joseph Layon, MD, Jerome H. Modell, MD, D. Sc. Drowing Anesthesiology 2009; 110: 1390–401.