Non-fatal drowning

Abstract

Introduction: Non-fatal drowning is a global public health issue, disproportionately affecting young populations. Pathophysiologically, fluid aspiration damages pulmonary surfactant, leading to hypoxemia and respiratory failure. Survival depends on quick rescue and early cardiopulmonary resuscitation (CPR), but sequelae can be severe, including multi-organ dysfunction. This case highlights the importance of recognizing and managing these complications.

Clinical Case: A 63-year-old woman with a history of hypertension, poorly controlled diabetes mellitus, and cerebrovascular disease suffered a traumatic brain injury after falling into a swimming pool and remaining submerged for 2 minutes. Initially reported with brain hemorrhage and absence of vital signs, she was resuscitated, intubated, and transferred to the Intensive Care Unit (ICU). She presented with distributive shock requiring two vasopressors (norepinephrine and vasopressin) and evidence of non-ST-elevation myocardial infarction. Regarding respiratory status, she experienced moderate distress (PaO2/FiO2 = 134). Her 33-day hospitalization (28 days in the ICU) was marked by severe multiorgan dysfunction, worsened by her comorbidities. She developed: acute kidney failure needing intermittent renal replacement therapy (dialysis); severe initial cardiac dysfunction (LVEF 36%) requiring recurrent vasopressor support; pulmonary sepsis and difficulty weaning from ventilation, leading to percutaneous tracheostomy; gastrointestinal complications, including lithiasic cholecystitis (requiring cholecystectomy) and gastrostomy due to swallowing difficulty; hemorrhage (nasogastric tube, mucous membranes, transvaginal) and anemia needing transfusions; severe critical myopathy (Daniels 2/5); and pressure ulcers (sacral grade 2).

Discussion: This case aligns with reports that identify female sex and advanced age as risk factors for accidental drowning. The patient's progression, characterized by drowning-related pneumonia, acute kidney injury, shock, and NSTEMI, is consistent with literature documenting the high morbidity associated with non-fatal drowning, especially in patients with pre-existing conditions.

Conclusion: Shock reversal and recovery of renal function were achieved. However, the case ended with severe sequelae—including dependent tracheostomy and gastrostomy, and profound myopathy—that prolonged prognosis and long-term care, emphasizing the significant disease burden of non-fatal drowning in vulnerable patients.