Drowning and immersion injuries in children.

Drowning and immersion injuries are leading causes of mortality and morbidity in children. An increasing amount of epidemiologic information is available. New modalities for managing respiratory failure, such as extracorporeal membrane oxygenation, are being explored. The realization that aggressive neurointensive care does not improve desirable outcome after near-drowning has led to investigations on preventing secondary brain injury that focus on monitoring and restoring cerebral oxygenation and circulation, reversing hypothermia, and maintaining normal blood glucose levels. Efforts at early neurologic prognostication and identification of victims who are likely to die or persist in a vegetative state are increasingly accurate and are highly relevant. Critical care physicians are more likely to withhold or withdraw support from victims who have minimal likelihood of meaningful recovery.