[Triage and treatment in juvenile drowning accidents].

Until 1977 the prognosis in childhood near drowning was rather poor. Many children died or survived permanently damaged by hypoxic encephalopathy. In the late seventies new methods of invasive neurointensive care were introduced in pediatric intensive care and were used in selected cases of near drowning. In one center (Hospital for Sick Children, Toronto) the prognosis in those children who remained comatose after the initial resuscitation was significantly improved with these methods. 14 personally observed cases of near-drowning are reported (1978-1980). During this time we were using invasive neurointensive care methods in selected cases (hyperventilation, cooling, barbiturates and others, combined with continuous intracranial pressure monitoring). Four children came under the category "clinical observation", 3 the category "artificial ventilation" (mainly for pulmonary reasons) and 5 the category "artificial ventilation and invasive neurointensive care". Two children were "brain dead" and showed significant cardiovascular instability at the time of ICU admission. Both died, while all the others survived: 11 were completely normal and 1 child was slightly retarded. We conclude that the prognosis in childhood near drowning can be greatly improved by triage, generous use of artificial ventilation and invasive neurointensive care in those children who remain deeply comatose after near drowning.