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J Trauma Inj : Journal of Trauma and Injury



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Original Articles
The Utility of Non-Invasive Nasal Positive Pressure Ventilation for Acute Respiratory Distress Syndrome in Near Drowning Patients
June Hyeong Kim, Kyung Hoon Sun, Yong Jin Park
J Trauma Inj. 2019;32(3):136-142.   Published online September 30, 2019
  • 7,633 View
  • 89 Download
  • 4 Citations
AbstractAbstract PDF

Near drowning refers to immediate survival after asphyxia due to submersion or immersion in water, which is a crucial public safety problem worldwide. Acute lung injury or acute respiratory distress syndrome (ARDS) is a common complication of near drowning. The purpose of this study was to investigate the feasibility and effectiveness of noninvasive nasal positive pressure ventilation (NINPPV).


This retrospective study was conducted at a tertiary emergency department. NINPPV was administered for moderate ARDS caused by submersion or immersion in patients who were older than 18 years, from January 2015 to December 2018. We collected the demographic (age, sex, length of hospital stay, and outcome), laboratory (arterial blood gas, lactate, oxygen saturation, partial pressure of oxygen divided by the fraction of inspired oxygen, complete blood count, blood urea nitrogen, and creatinine), and clinical data (acute lung injury index and ventilator failure) of the patients. A statistical analysis was performed using Statistical Package for the Social Sciences version 20.0 for Windows.


NINPPV treatment was provided to 57 patients for near drowning, 45 of whom (78.9%) were successfully treated without complications; in 12 (21.1%), treatment was changed to invasive mechanical ventilation within 48 hours due to ARDS or acute kidney injury. NINPPV treatment was successful in 31 (75.6%) out of 41 sea-water near drowning patients. They were more difficult to treat with NINPPV compared with the fresh-water near drowning patients (p<0.05).


NINPPV would be useful and feasible as the initial treatment of moderate ARDS caused by near drowning.



Citations to this article as recorded by  
  • Early pronation, protective lung ventilation and use of awake-prone-HFNO therapy after extubation in near-fatal drowning
    G. Misseri, P. Pierucci, D. Bellina, M. Ippolito, G. Ingoglia, C. Gregoretti
    Pulmonology.2024; 30(2): 198.     CrossRef
  • Addressing gaps in our understanding of the drowning patient: a protocol for the retrospective development of an Utstein style database and multicentre collaboration
    Ogilvie Thom, Kym Roberts, Peter A Leggat, Susan Devine, Amy E Peden, Richard Charles Franklin
    BMJ Open.2023; 13(2): e068380.     CrossRef
  • Management for the Drowning Patient
    David Szpilman, Paddy J. Morgan
    Chest.2021; 159(4): 1473.     CrossRef
  • Treatment of the lung injury of drowning: a systematic review
    Ogilvie Thom, Kym Roberts, Susan Devine, Peter A. Leggat, Richard C. Franklin
    Critical Care.2021;[Epub]     CrossRef
Therapeutic Role of Inhaled Nitric Oxide for Acute Respiratory Failure in the Early Phase of Trauma
Byoung Sung Kim, Kyu Hyouck Kyoung, Hojong Park
J Trauma Inj. 2015;28(3):104-107.   Published online September 30, 2015
  • 1,673 View
  • 3 Download
AbstractAbstract PDF
Nitric oxide (NO) is a vasodilator and inhaled NO (iNO) is used in acute respiratory distress syndrome (ARDS) to improve alveolocapillary gas exchange. The mechanism to improve oxygenation is likely to redistribute blood flow from unventilated areas to ventilated areas. Though improvement of oxygenation, iNO therapy has not been shown to improve mortality and considered as only rescue therapy in severe hypoxemia. We conducted the study to investigate an efficacy of iNO in trauma patients with severe hypoxemia.
We reviewed the trauma patients who underwent iNO therapy retrospectively from 2010 to 2014. Degree of hypoxemia was represented as PaO2/FiO2 ratio (PFR) and the severity of patient was represented with sequential organ failure assessment (SOFA) score. Patients were divided into the survivor group and non-survivor group according to the 28-day mortality.
A total of 20 patients were enrolled. The mortality of 28-day was 40%. There were no significant differences between survivor and non-survivor group in age, sex, severity of injury, PFR and SOFA score. There was significant difference in initiation time of iNO after injury (p=0.047). Maximum combinations of sensitivity and specificity for timing of iNO therapy were observed using cut-off of 3-day after injury with a sensitivity of 88% and specificity of 75%.
Though iNO therapy does not influence the mortality, iNO therapy may decrease the mortality caused by respiratory failure in the early phase of trauma.
Case Reports
Application of Extracorporeal Membranous Oxygenation in Trauma Patient with Possible Transfusion Related Acute Lung Injury (TRALI)
Dae Sang Lee, Chi Min Park
J Trauma Inj. 2015;28(1):34-38.   Published online March 30, 2015
  • 1,682 View
  • 5 Download
  • 1 Citations
AbstractAbstract PDF
The case of a patient with a transfusion-related acute lung injury (TRALI) to whom extracorporeal membrane oxygenation (ECMO) had been applied is reported. A 55-year-old male injured with liver laceration (grade 3) without chest injury after car accident. He received lots of blood transfusion and underwent damage control abdominal surgery. In the immediate postoperative period, he suffered from severe hypoxia and respiratory acidosis despite of vigorous management such as 100% oxygen with mechanical ventilation, high PEEP and muscle relaxant. Finally, ECMO was applied to the patients as a last resort. Aggressive treatment with ECMO improved the oxygenation and reduced the acidosis. Unfortunately, the patient died of liver failure and infection. TRALI is a part of acute respiratory distress syndrome (ARDS). The use of ECMO for TRALI induced severe hypoxemia might be a useful option for providing time to allow the injured lung to recover.


Citations to this article as recorded by  
  • A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion
    Ki Sul Chang, Dae Won Jun, Youngil Kim, Hyunwoo Oh, Min Koo Kang, Junghoon Lee, Intae Moon
    The Korean Journal of Blood Transfusion.2015; 26(3): 309.     CrossRef
Extracorporeal Membrane Oxygenation Treatment of Traumatic Lung Injury: 2 Cases
Jin Sung Yang, Hwakyun Shin, Keun Her, Yong Soon Won
J Korean Soc Traumatol. 2011;24(2):155-158.
  • 1,080 View
  • 1 Download
AbstractAbstract PDF
Mechanical ventilation is usually the treatment of choice for severe respiratory failure associated with trauma. However, in case of severe hypoxia, mechanical ventilation may not be sufficient for gas exchange in lungs. Patients with Acute Respiratory Distress Syndrome (ARDS) undergo difficulties in oxygen and carbon dioxide exchange. Extracorporeal Membrane Oxygenation (ECMO) is the ideal therapeutic option for those patients with severe traumatic injuries. ECMO allows lungs to reserve their functions and decreases further lung injuries while increasing survival rate at the same time. We report two cases of patients with traumatic ARDS and Multiple Organ Failure including compromised heart function. The preservation of lung function was successful using ECMO therapy.

J Trauma Inj : Journal of Trauma and Injury