Study design
We performed a single-center retrospective chart review in the pediatric
emergency department of the Dokuz Eylul University Faculty of Medicine,
a tertiary hospital with approximately 120000 pediatric emergency
department admissions per annum. The study was approved by the
Institutional Review Board of the Dokuz Eylul University Faculty of
Medicine (approval number: 2020/01-11).
Children aged between 0 and 18 years who were referred to the pediatric
emergency department due to drowning-related pulmonary edema and
underwent NIV treatment between May 2014 and October 2020 were included.
The International Classification of Diseases (ICD) codes for drowning,
near drowning, immersion, and submersion injuries were used to identify
patients. We obtained information from a computer database, electronic
medical records, medical charts, and nursing records of the cases.
Patients were excluded if they had chronic pulmonary, cardiac, or
neuromuscular diseases; if they were transferred from another hospital;
and if there were insufficient data.
The following data were recorded: demographic data; initial body
temperature and Glasgow Coma Scale (GCS) score; heart rate; respiratory
rate (RR); peripheral oxygen saturation (SpO₂); blood pressure; fraction
of inspired oxygen (FiO₂); SpO₂/FiO₂ (S/F) ratio at 0, 1, 2, 4, 8, and
12 hours; clinical findings; and results of the laboratory and
radiologic investigations and applied treatments. Using findings at
arrival to the pediatric emergency department, patients were divided
into 6 groups using the Szpilman classification system as follows: grade
1, normal pulmonary auscultation with coughing; grade 2, abnormal
pulmonary auscultation with rales in some pulmonary fields; grade 3,
pulmonary auscultation of acute pulmonary edema without arterial
hypotension; grade 4, pulmonary auscultation of acute pulmonary edema
with arterial hypotension; grade 5, isolated respiratory arrest; and
grade 6, cardiopulmonary arrest ¹³.
Non-invasive ventilation strategies were divided into two groups as
continuous (CPAP) or bi-level (BiPAP) positive airway pressure
[spontaneous, spontaneous/timed (ST), or timed mode for NIV
ventilators (Philips Respironics V60 ventilator, USA); A/C pressure or
PSV mode for conventional ventilators with NIV option (Maquet Servo I,
Germany)].
The time between arrival to the pediatric emergency department and
starting NIV application, total duration time and observed side effects
during NIV treatment, need for IMV, need for pediatric intensive care
unit (PICU) admission, and total length of stay in the PICU and in the
hospital were recorded for each patient.