Stručni rad
NONINVASIVE VENTILATION IN DROWNING VICTIMS AT THE EMERGENCY DEPARTMENT, RIJEKA UNIVERSITY HOSPITAL CENTRE
EDITA BREŠKI
; Klinički bolnički centar Rijeka, Objedinjeni hitni bolnički prijam, Rijeka, Hrvatska
ANDRIJANA MARTINOVIĆ ŠTEKOVIĆ
; Klinički bolnički centar Rijeka, Objedinjeni hitni bolnički prijam, Rijeka, Hrvatska
TATJANA MILETA
; Klinički bolnički centar Rijeka, Objedinjeni hitni bolnički prijam i Sveučilište u Rijeci, Medicinski fakultet, Katedra za anesteziologiju, reanimatologiju, hitnu i intenzivnu medicine, Rijeka, Hrvatska
MARTINA PAVLETIĆ
; Klinički bolnički centar Rijeka, Objedinjeni hitni bolnički prijam, Rijeka, Hrvatska
Sažetak
Introduction: Drowning is the result of submersion in a fl uid, leading to hypoxia, acidosis, hypothermia, arrhythmia and multiorgan failure and death. Oxygen therapy is the main treatment option. For the past few years, the Emergency Department (ED) uses noninvasive ventilation (NIV) in patients with acute respiratory failure. Because of positive effects on hemodynamics and respiration, there is no need of conventional mechanical ventilation. There are two modalities, i.e. continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP). NIV is recommended as the main therapeutic option. Routine use of corticosteroids, diuretics and empirical antibiotics is not recommended. Considering the increased number of drowning victims in the ED that were treated with NIV, this study analyzed the trend of using NIV and its effectiveness as the main therapeutic option. Other data from medical records of drowning victims were also analyzed. Objective: The aim of this study was to inspect compatibility with the existing recommendations and guidelines, and the effectiveness of NIV in the treatment of drowning victims at the Rijeka University Hospital Centre ED in the period from January 1, 2017 until December 31, 2019. Methods: A total of 98 drowning victims were included in the study. Data from medical records during the investigated period were retrospectively analyzed. The level of statistical signifi cance was set at 95% (p<0.05). Results: A higher percentage of drowning victims were males, mean age 65.9 years. The target value of oxygen saturation above 92% was reached. NIV was applied in the majority of drowning victims (39%). There was a statistically signifi cant difference in the effectiveness of NIV versus oxygen supplementation. During the study period, a signifi cant increase in the use of NIV was recorded (χ2=5.96; p=0.049). The noncritical use of diuretics, corticosteroids, fl uids and antibiotics (more than 2/3 of drowning cases) were captured. The average hospital stay was 2 days (34%). On admission to the hospital, the largest number of patients had Glasgow Coma Score (GCS) 15 (82.7%). The most common cause was of cardiac origin (31%). Discussion: The results obtained were compatible with epidemiological data of the World Health Organization. There was a statistically signifi cant difference in the greater effi ciency of NIV as compared with oxygen supplementation. Owing to the better availability of equipment, educated medical personnel and extended indications, NIV becomes the main therapeutic option in drowning victims at ED. There is still a noncritical administration of diuretics, corticosteroids and antibiotics. The administration of liquid via parenteral route is recommended in cases of refractory hypotension with or without vasopressors, but this was not the case in this study. The average length of hospital stay was 48 hours, as opposed to the recommended 24 hours when drowning victims are in good general condition. Most of drowning victims had GCS 15, which is considered a positive factor according to similar studies. The most common etiologic cause was of cardiac origin, which differed from other studies. Conclusion: The use of NIV is more common in drowning victims at ED. It proved to be more effective than oxygen supplementation. Compliance with current guidelines and recommendations was not complete. Therefore, standardized protocols are required.
Ključne riječi
drowning; oxygen; noninvasive ventilation; emergency hospital admission
Hrčak ID:
237942
URI
Datum izdavanja:
24.4.2020.
Posjeta: 1.253 *