NEUROLOGIC

The majority of long term sequalae of drowning events are secondary to neurologic injury. Early efforts should be made to improve central nervous system oxygen delivery while providing evidence-based neuroprotection in the post-resuscitative period.

- Maintain adequate oxygenation of SaO2 >92%. *In the intubated post arrest patient, hyperoxia (PaO2 >300mmHg) is associated with poor neurologic outcomes.41 Consider placement of an arterial line to monitor PaO2.
- Maintain systemic mean arterial pressure > 65mmHg to ensure adequate cerebral perfusion (cerebral perfusion pressure = mean arterial pressure – intracranial pressure). Low dose vasopressor support may be necessary. As discussed above, in military drowning patients with an abnormal neurologic exam and persistent hypotension, ICU caregivers must rule out traumatic injury and hemorrhage as a cause of hypotension. * There is no evidence to support invasive intracranial pressure monitoring or supranormal cerebral perfusion pressures.23
- Maintain head of bed at 30 degrees with head midline.
- Only aggressive fever prevention is recommended. Cooling with targeted temperature management is NOT recommended.24

In patients who are still rewarming, aggressive shivering control should be implemented (See Figure 2 on right for an example of shivering management protocol). Significant adverse effects from prolonged shivering include lactic acidosis, elevated intracranial pressure, rhabdomyolysis, discomfort, and interference with monitoring devices.24