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Drowning in fresh or salt water

respective influence on respiratory function in a matched cohort study

Michelet, Pierrea; Dusart, Mariona; Boiron, Laurencea; Marmin, Juliena; Mokni, Tarakd; Loundou, Andersonc; Coulange, Mathieub; Markarian, Thibauta

European Journal of Emergency Medicine: August 03, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MEJ.0000000000000564
Original article: PDF Only

Introduction For the most severe drowned patients, hypoxemia represents one of the major symptoms. As the influence of the type of water (fresh or salt water) on respiratory function is still unclear, the primary endpoint of this multicenter study was to compare hypoxemia according to the type of water.

Methods Medical records of adult patients who experienced a drowning event and were consequently admitted to 10 ICU for acute respiratory failure were analyzed retrospectively using data collected over three consecutive summer periods. From an initial cohort of acute respiratory failure drowned patients, patients were matched by age, sex, Glasgow Coma Scale, and occurrence of cardiac arrest (yes or no).

Results Among an initial cohort of 242 patients, 38 pairs were matched correctly. At the initial assessment, carried out upon ICU admission, hypoxemia was found to be deeper in the fresh water group (PaO2/FiO2: 141±76 vs. 220±122, P<0.05). However, there was no significant difference in tissue oxygenation (assessed by blood lactate level) between groups. In terms of biology results, sodium levels were higher in the salt water group in the initial assessment (144±6.8 vs. 140±5.2 mmol/l, P=0.004), but no difference was observed later. No difference was recorded in the outcome or length of stay in ICU between groups.

Conclusion Drowning in fresh water was associated with deeper hypoxemia in the initial assessment. Despite this initial difference, latter respiratory and biological parameters or outcome were similar in both groups.

aEmergency Department, Timone University Hospital

bDepartment of Hyperbaric Medicine, Sainte Marguerite Hospital, Marseille

cDepartment of Public Health, EA3279 Self-perceived Health Assessment Research Unit, Timone University, Aix-Marseille University

dEmergency Department (SAMU 64), Côte Basque Hospital, Bayonne, France

Correspondence to Pierre Michelet, MD, PhD, Emergency Department, Timone University Hospital, Sainte Marguerite Hospital, Aix-Marseille University, 13005 Marseille, France Tel: +33 638 741 313; fax: +33 491 386 943; e-mail:

Received October 10, 2017

Accepted May 1, 2018

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