Kriz Daniel, Piantino Juan, Fields Devin, Williams Cydni
Department of Pediatrics, Division of Psychology, Neuro-Critical Care Program, Oregon Health and Science University, Portland, OR 97239, USA.
Programs for Evaluation, Development and Learning, St. Charles Healthcare Systems, Bend, OR 97701, USA.
Children (Basel). 2017 Dec 27;5(1):4. doi: 10.3390/children5010004.
Drowning is the 3rd leading cause of unintentional injury death worldwide, with the highest rates of fatality among young children. Submersion injuries with cardiac arrest can lead to long-term neurologic morbidity. Severe hypothermic submersion injuries have complex treatment courses and survivors have variable neurocognitive outcomes. We describe the course of a hypothermic submersion injury in a 6-year-old previously healthy boy. The description includes premorbid and post-injury neurocognitive functioning. A review of the literature of pediatric cold-water submersion injury was performed. Despite prolonged cardiopulmonary resuscitation (>100 min) and water temperature well above freezing, our patient had an optimal neurocognitive outcome following hypothermic submersion injury. Available literature is limited but suggests that increased submersion time, increased duration of resuscitation, and higher water temperatures are associated with worse outcomes. Care guidelines have been created, but outcomes related to these guidelines have not been studied. Our case highlights potential important determinants of outcome after drowning. Incident specific characteristics and therapeutic interventions should be considered when evaluating this population. Treatment guidelines based on currently available literature may fail to incorporate all potential variables, and consideration should be given to prolonged resuscitative efforts based on individual case characteristics until further data is available.
溺水是全球意外伤害死亡的第三大原因，幼儿的死亡率最高。心脏骤停导致的浸没伤可引发长期神经功能障碍。严重低温浸没伤的治疗过程复杂，幸存者的神经认知结果各异。我们描述了一名6岁既往健康男孩的低温浸没伤病程。描述包括伤前和伤后神经认知功能。对小儿冷水浸没伤的文献进行了综述。尽管进行了长时间的心肺复苏（>100分钟）且水温远高于冰点，但我们的患者在低温浸没伤后仍获得了最佳的神经认知结果。现有文献有限，但表明浸没时间延长、复苏持续时间增加和水温升高与更差的结果相关。已制定了护理指南，但尚未研究与这些指南相关的结果。我们的病例突出了溺水后可能影响结果的重要决定因素。评估该人群时应考虑具体事件特征和治疗干预措施。基于现有文献的治疗指南可能无法纳入所有潜在变量，在获得更多数据之前，应根据个体病例特征考虑延长复苏努力。
