RESULTS
There were 27 patients during the study period and, of them, 25 were enrolled. The median age was 6.7 years (IQR: 4.1-11.8). Of the patients, 18 (72.0%) were male. Seventeen (68.0%) drownings occurred in saltwater and 8 (32.0%) in freshwater. The initial GCS score was 15 for 14 (56.0%) patients, 14 for 6 (24.0%) patients, 13 for 3 (12.0%) patients, and 12 for 2 (8.0%) patients. According to the Szpilman classification, 13 (52.0%) patients were evaluated as grade 3 and 12 (48.0%) as grade 4. Four patients (16.0%) received CPR at any time between rescue from the scene and the hospital, the duration ranging between 1.5 and 5 minutes. The clinical and laboratory findings of the patients are summarized in Table 1. The chest X-rays of all patients revealed acute pulmonary edema. Treatment with 10-12 L/min oxygen by a non-rebreather face mask with a reservoir was administered for all children during the time interval between arrival to the pediatric emergency department and the start of NIV application.
All patients received BiPAP therapy in ST mode using oronasal or full-face masks, inspiratory positive airway pressure (IPAP) in the range of 8-18 cmH₂O, and expiratory positive airway pressure (EPAP) in the range of 4-10 cmH₂O. For 13 (52.0%) patients, BiPAP therapy was started in the first hour, while for 12 (48.0%) it was started between 1 and 4 hours after arrival to the pediatric emergency department. A significant increase in S/F ratios was observed from the beginning of NIV treatment and this increase was also observed for the 2nd, 4th, 8th, and 12th hours (p <0.05) (Figure 1). A significant increase in SpO₂ values was also observed from the start of NIV use and the same increase was observed for the 2nd and 4th hours (p <0.05) (Figure 2). There was a decrease in RR at the 4th hour of NIV treatment (p <0.05) (Figure 3). The median length of NIV use was 7.0 hours (IQR: 5.2-12.5). No side effects were observed during NIV treatment. Of all NIV applications, no patient subsequently deteriorated to IMV.
Of the 25 patients, 10 (40.0%) were admitted to the PICU, and 15 (60.0%) of them were observed in the pediatric emergency department and then discharged. All patients who were admitted to the PICU had Szpilman scores of grade 4. Of the 15 patients who were discharged from the emergency department, 13 (86.6%) of them had a Szpilman score of grade 3 and 2 (13.4%) had a score of grade 4; children who were admitted to the PICU had higher Szpilman scores (p <0.001). The mean duration of NIV treatment was also longer in children who were admitted to the PICU (admitted: 13.4±4.8 hours, not admitted: 6.1±2.6 hours;p <0.001). There was no difference in PICU admission rates, duration of NIV treatment, or length of stay in the PICU or the hospital for drownings that occurred in fresh versus saltwater. The mean length of stay in the PICU was 19.3±3.0 hours and the median length of stay in the hospital was 28.0 hours (IQR: 20.0-53.0).