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Introduction: We report a case of twin toddlers who both suffered near drowning but with different post-trauma treatment and course, and different neurological outcomes., Methods and Results: Two twin toddlers (a boy and girl, aged 2 years and 3 months) suffered hypothermic near drowning with protracted cardiac arrest and aspiration. The girl was treated with mild hypothermia for 72 hours and developed acute respiratory dysfunction syndrome and sepsis. She recovered without neurological deficit. The boy's treatment was conducted under normothermia without further complications. He developed an apallic syndrome., Conclusion: Although the twin toddlers experienced the same near drowning accident together, the outcomes with respect to neurological status and postinjury complications were completely different. One of the factors that possibly influenced the different postinjury course might have been prolonged mild hypothermia.

A retrospective study was conducted to evaluate the outcome of near-drowning patients admitted to the intensive care unit (ICU) comparing seawater and freshwater drownings. A chart review was used to identify near-drowning patients admitted to ICU from 1 April 1989 to 1 May 1996 for biodata, physiological data and outcome. Seventeen near-drowning patients were admitted to ICU over a period of nearly 7 years. There were 3 deaths (17.6%) and 8 patients (47%) required cardiopulmonary resuscitation. Freshwater near-drowning occurred in 8 patients and saltwater near-drowning occurred in 9 patients. Nearly all (94%) the patients had a PaO2/FiO2 ratio < 300 mm Hg. Pulmonary oedema was present on the chest radiographs of all patients. Mechanical ventilation was required for 8 patients (47%), and nearly all (94%) received prophylactic antibiotics. None of the patients developed pneumonia. Serum electrolytes and haemoglobin concentration were not grossly abnormal although, those with saltwater near-drowning had a significantly higher level of haemoglobin, sodium and urea compared to those with freshwater near-drowning. Patients that survived to hospital discharge had full neurological recovery and stayed an average of 4.5 days. We concluded that near-drowning victims that survive to be admitted to ICU have significant oxygenation defect with nearly half requiring ventilatory support. Mortality is appreciable, but those that survive to hospital discharge had full neurological recovery.

Young children continue to be victims of drowning and near-drowning. The pediatric critical care nurse is often called upon to care for a child following a near drowning event. The role of the nurse in assessment, early intervention and continuing critical care management, and primary prevention of water-related injuries are reviewed.

If no complications arise, the near-drowning victim is usually discharged within 48 hours. However, some patients require complex care because of multisystem failure. These patients challenge the critical care nurse, who must understand the interrelationships of the problems to provide quality care. The major focus of care is stabilization and normalization of the cardiovascular, respiratory and neurologic systems through accurate nursing assessments and implementation of appropriate nursing care.

The incidence, epidemiology, and pathophysiology of drowning and near-drowning are presented. Particular attention is paid to the neurologic and pulmonary pathophysiology indicators for monitoring and laboratory tests. Special attention to transportation of patients is given, and treatment in the field, emergency department, and pediatric intensive care unit is delineated.

Near-drowning is a frequently preventable accident that has significant morbidity and mortality for a previously healthy population. It causes an hypoxic-ischemic insult and multisystem organ dysfunction. Effective and aggressive CPR at the scene is the most important therapy presently available. Children needing CPR in an emergency room setting have poor outcome unless the submersion incident occurred in ice-water and the patient is hypothermic upon arrival in the emergency room. Attempts at prevention through parent education, requiring of CPR certification for pool owners, and legislation of barriers around the pool are critical because treatment to improve the outcome of the neurologic insult has proved ineffective.