Overview of drowning and near-drowning in children and management in the intensive care unit

Submersion injuries, including drowning and near-drowning, remain a major yet largely preventable public health concern in children, accounting for more than 360,000 deaths worldwide each year.Underlying medical conditions such as epilepsy and autism, alcohol use, and inadequate supervision are well-established risk factors for submersion injury.Aspiration of water following submersion leads to hypoxia, which subsequently results in multisystem organ injury and is the primary determinant of morbidity and mortality.The brain, lungs, and heart are most frequently affected, and disseminated intravascular coagulation is also commonly observed.Management of pediatric submersion injuries in the intensive care unit should be highly individualized.In patients requiring ongoing resuscitation, resuscitative efforts should be continued until an acceptable core body temperature is achieved, and extracorporeal cardiopulmonary resuscitation may be considered in selected cases.In patients who do not require continued resuscitation, management should focus on supportive care for organ dysfunction.Monitoring of intracranial pressure and seizures may be necessary.Mechanical ventilation strategies generally follow established recommendations for pediatric acute respiratory distress syndrome, and extracorporeal membrane oxygenation may be considered in refractory respiratory failure.Importantly, the potential benefits and risks of each therapeutic intervention must be carefully weighed on an individual basis, as some treatments may exert opposing effects on different organ systems.Prognosis is most strongly associated with the duration of submersion.Prevention, particularly through appropriate supervision and the use of physical barriers, remains the most effective intervention.A comprehensive understanding of the epidemiology, pathophysiology, risk factors, and critical care management of submersion injury is essential for improving outcomes in pediatric intensive care units.