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Early application of non-invasive ventilation for children with pulmonary edema after drowning.

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.