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Drowning and near-drowning are major causes of death and neurological damage, respectively, in children. The pathophysiological substrate consists of hypoxia, ischaemia, respiratory and metabolic acidosis and sometimes, hypothermia. Most cases involve aspiration of liquid; this leads to a persistent impairment of the gas exchange. Occurrence of arrhythmias and hypovolaemia is very likely. The main objective of treatment of the near-drowned is limiting cerebral damage. Treatment consists of resuscitation and stabilization, administration of oxygen with positive end-expiratory pressure, intravenous administration of liquids and central reheating. The prognosis depends in the first place on the duration of the submersion, which, however, is often difficult to establish. Submersion for over 5 minutes is prognostically unfavourable. In hypothermia due to submersion in ice cold water the prognostic factors are less clear--in these cases the treatment should always be continued until the core temperature is > or = 32 degrees C.

Objective: To evaluate the occurrence of the adult respiratory distress syndrome (ARDS), and of hypothermia as a predictor of outcome in cases of submersion injury in children., Design: Retrospective analysis., Patients: All drowning cases admitted to the Intensive Care Unit of the Wilhelmina Children's Hospital in Utrecht between January 1986 and January 1993., Results: There were 45 patients, 29 boys and 16 girls, aged 0-13 years. Hypothermia was related to the duration of submersion and did not correlate with a good outcome. Asystole on arrival at the hospital was associated with demise in all but one patient, who was left with severe neurological impairment. ARDS occurred in 27/45 patients (60%), all within 6 h following admission. Of the 45 patients treated, 11 died. Of the 34 survivors, 7 were discharged from the Intensive Care Unit with neurological sequelae (2 with mild, 5 with serious sequelae)., Conclusion: In our patients with drowning accidents, hypothermia did not appear to provide any protective effect. ARDS, if it occurred, became evident within 6 h after admission.