SciELO - Scientific Electronic Library Online

 
vol.6 issue4Informações sobre o uso de medicamentos no esporteReabilitação cardiovascular: custo-benefício author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Revista Brasileira de Medicina do Esporte

Print version ISSN 1517-8692

Rev Bras Med Esporte vol.6 no.4 Niterói July/Aug. 2000

http://dx.doi.org/10.1590/S1517-86922000000400005 

ARTIGO DE REVISÃO

 

Afogamento

 

 

David Szpilman

Médico do Centro de Recuperação de Afogados da Barra da Tijuca – GMAR – CBMERJ; Médico do Hospital Municipal Miguel Couto – CTI; Sócio Fundador e ex-presidente da Sociedade Brasileira de Salvamento Aquático – SOBRASA; Membro da "International Lifesaving Federation Medical Commission"

Endereço para correspondência

 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

AGRADECIMENTOS

O autor agradece aos médicos do Centro de Recuperação de Afogados (CRA-GMAR-CBMERJ) e Hospital Municipal Miguel Couto e, especialmente, aos guarda-vidas, pela constante ajuda e carinho com as vítimas de afogamento.

 

REFERÊNCIAS

1. Gooden BA. Drowning and the diving reflex in man. Department of human Physiology and Pharmacology University of Adelaide. Med J Aust 1972;2:583-7.         [ Links ]

2. Dietz PE, Baker SP. Drowning: epidemiology and prevention. Am J Public Health 1984;64:303-12.         [ Links ]

3. DeNicola LK, Falk JL, Swanson ME, Gayle MO, Kissoon N. Submersion injuries in children and adults. Crit Care Clin 1997;13:477-502.         [ Links ]

4. Branche CM. What is really happening with drowning rates in the United States? In: Fletemeyer JR, Freas SJ, editors. Drowning – New Perspectives on Intervention and Prevention. CRC Press, 1998:31-42.         [ Links ]

5. Secretaria Estadual de Saúde do Rio de Janeiro, Departamento de dados vitais – <www.ses.rj.gov.br> – Ministério da Saúde, Datasus,         [ Links ] 1998.

6. Szpilman D. Drownings on the beaches of Brazil. In: Fletemeyer JR, Freas SJ, editors. Drowning – New perspectives on intervention and prevention. CRC Press, 1998:125-46.         [ Links ]

7. Szpilman D, Tomáz N, Amoedo AR. Afogamento. In: Bethlen N. Pneumologia. 4ª ed. Atheneu, 1995:903-19.         [ Links ]

8. Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases. Chest 1997; 112:660-5.         [ Links ]

9. Peterson B. Morbility of childhood near-drowning. Pediatrics 1977; 59:364-70.         [ Links ]

10. Nagel FO, Kibel SM, Beatty DW. Childhood near-drowning – Factors associated with poor outcome. SAMJ 1987;78:442-25.         [ Links ]

11. Briefing Package on Child Drownings in Residential Pools. Whashington, DC: U.S. Consumer Product Safety Commission, 1987.         [ Links ]

12. Orlowski JP, Abulleil MM, Phillips JM. Effects of tonicities of saline solutions on pulmonary injury in drowning. Crit Care Med 1987;15:126.         [ Links ]

13. Szpilman D, Amoedo AR. Afogamento. JAMA-Clínica Pediátrica 1995; 19:5-20.         [ Links ]

14. Shuman SH, Rowe JR, Glazer HM, et al. The iceberg phenomenon of near-drowning. Crit Care Med 1976;4:127.         [ Links ]

15. Modell JH. Pathophysiology and treatment of drowning and neardrowning. Springfield: Charles C. Thomas, 1971.         [ Links ]

16. Modell JH. Drown versus near-drown: a discussion of definitions. Crit Care Med 1981;9:351-2.         [ Links ]

17. Jacobsen JB, Nielsen H, Ringsted C, et al. Drowning and near-drowning (letter). Crit Care Med 1980;8:529-30.         [ Links ]

18. Hoff BH: Drowning and near-drowning (letter). Crit Care Med 1980; 8:530.         [ Links ]

19. Bierens JJLM, Huet RCG, Turner NM, Berkel M, Knape JTA. Resuscitation guidelines; controversies and pitfalls in case of submersion (Submitted for publication).         [ Links ]

20. Cummins RO. The Utstein-style for uniform reporting of data from out of hospital cardiac arrest. Ann Emerg Med 1993;22:37-40.         [ Links ]

21. Szpilman D, Amoedo AR. Manual de afogamento e ressuscitação cardiorrespiratória. Revinter, 1995.         [ Links ]

22. Sincock AD. Treatment of near-drowning – A review of 130 cases. Anaesthesia 1986;41:643-8.         [ Links ]

23. Mullanney PJ. Acute immersion syndrome. Postgrad Med 1970;48: 89-91.         [ Links ]

24. Tipton MJ, Kelleher PC, Golden FST. Supraventricular arrythmias following breath hold submersion in cold water. Undersea Hyperb Med 1994;21:305-13.         [ Links ]

25. Modell JH, Ketover A. Clinical course of 91 consecutive near-drowning victims. Chest 1976;70:2. Lancet 1974;II:1361.         [ Links ]

26. Modell JH, Davis JH, Giammona ST, et al. Blood gas and electrolyte changes in human near-drowning victims. JAMA 1968;203:99.         [ Links ]

27. Modell JH, Moya F, Willians HD, Weibley TC. Changes in blood gases and A-aDo2 during near-drowning. Anesthesiology 1968;29:456-65.         [ Links ]

28. Modell JH. Serum electrolyte changes during drowning and near drowning. Bulletin of Pathology1966:304-11.         [ Links ]

29. Modell JH, Gaub M, Moya F, Vestal B, Swars H. Physiologic effects of near drowning with chlorinated fresh water, distilled water and isotonic saline. Anesthesiology 1966;27:33-41.         [ Links ]

30. Guidelines for cardiopulmonary resuscitation and emergency cardiac care (ECC). JAMA 1992;268:2171-260.         [ Links ]

31. Orlowski JP, Abulleil MM, Phillips JM. The hemodynamic and cardiovascular effects of near-drowning in hipotonic, isotonic, or hipertonic solutions. Ann Emerg Med 1989;18:1044-9.         [ Links ]

32. Giammona ST, Modell JH. Drowning by total immersion, effects on pulmonary surfactant of distilled water, isotonic saline and sea water. Am J Dis Child 1967;114.         [ Links ]

33. Bergquist RE, Vogelhut MM, Modell JH, Sloan SJ, Ruiz BC. Comparison of ventilatory patterns in the treatment of freshwater near-drowning in dogs. Anesthesiology 1980;52:142-8.         [ Links ]

34. Tabeling BB, Modell JH. Fluid administration increases oxygen delivery during continuous positive pressure ventilation after freshwater neardrowning. Crit Care Med 1983;11:693-6.         [ Links ]

35. Greenberg MI, Baskin SI, Kaplan RM, Unichio FJ. Effects of endotracheally administered distilled water and normal saline of the arterial blood gases of dogs. Ann Emerg Med 1982;11:600-4.         [ Links ]

36. Bierens JJLM, Van der Velde EA, Van Berkel M, et al. Submersion cases in the Netherlands. Ann Emerg Med 1989;18:366-73.         [ Links ]

37. Dunagan DP, Cox JE, Chang MC, Haponik EF. Sand aspiration with near-drowning – Radiographic and bronchoscopic findings, case report. Am J Respir Crit Care Med 1997;156:292-5.         [ Links ]

38. Modell JH, Davis JH. Electrolyte changes in human drowning victims. Anesthesiology 1969;30:414-20.         [ Links ]

39. Fuller RH. The 1962 Wellcome prize essay. Drowning and the postimmersion syndrome. A clinicopathologic study. Mil Med 1963;128: 22-36.         [ Links ]

40. Swann HG, Brucer M. The cardiorespiratory and biochemical events during rapid anoxic death. VI. Freshwater and sea water drowning. Tex Rep Biol Med 1949;7:604-18.         [ Links ]

41. Swann HG, Brucer M, Moore C, Vezien BL. Freshwater and sea water drowning: a study of the terminal cardiac and biochemical events. Tex Rep Biol Med 1947;5:423-37.         [ Links ]

42. Szpilman D, Amoedo AR. Atualização da classificação de afogamento: avaliação de 2.304 casos em 20 anos. JBM 1994;66:21-37.         [ Links ]

43. Modell JH, Graves SA, Kuck EJ. Near-drowning: correlation of level of consciousness and survival. Can Anaesth Soc J 1980;27:211-5.         [ Links ]

44. Safar P, Lane JC. Afogamento: reanimação cardiopulmonar. 1ª ed. Guanabara Koogan, 1981.         [ Links ]

45. Munrae WD. Hemoglobinuria from near-drowning. J Pediatr 1964;64: 57-62.         [ Links ]

46. Rosenbaum T, Thompson L, Fuller RH. Radiographic pulmonary changes in near-drowning. Department of radiology, University of Wisconsin, 1964;83:306-13.         [ Links ]

47. Grausz, et al. Acute renal failure complicating submersion in sea water. JAMA 1971;217:207-9.         [ Links ]

48. Bierens JJLM, Uytslager R, Swenne-van Ingen MME, et al. Accidental hypothermia: incidence, risk factors and clinical course of patients admitted to hospital. EJEM 1995;2:38-46.         [ Links ]

49. Conn AW, Barker GA. Fresh water drowning and near-drowning – an update. Can Anaesth Soc J 1984;31:S38-S44.         [ Links ]

50. Special Resuscitation Situations – Near-drowning, An Advisory Statement from the International Liaison Committee on Resuscitation. Circulation 1997;95:2199.         [ Links ]

51. Berkel M, Bierens JJLM, Lierlk, et al. Pulmonary oedema, pneumonia and mortality in submersions victims. A retrospective study in 125 patients. Intensive Care Med 1996;22:101-7.         [ Links ]

52. Stiell IG, Herbert PC, Weitzman BN, et al. High-dose epinephrine in adult cardiac arrest. N Engl J Med 1992;327:1045-50.         [ Links ]

53. Sherman BW, Munger MA, Panacek EA, Foulke GE, Rutherford WF. High-dose epinephrine in patients failing prehospital resuscitation (abstract). Ann Emerg Med 1991;20:949.         [ Links ]

54. Goetting MG, Paradis NA. High-dose epinephrine improves outcome from pediatric cardiac arrest. Ann Emerg Med 1991;20:22-6.         [ Links ]

55. Bierens JJLM, Velde EA, Berkel M, Zanten JJ. Submersion in the Netherlands; prognostic indicators and results of resuscitation. Ann Emerg Med 1990;19:1390-5.         [ Links ]

56. Manolios N, Mackie I. Drowning and near-drowning on Australian beaches patrolled by life-saves: a 10 year study, 1973-1983. Med J Aust 1988;148:165-71.         [ Links ]

57. Peitzman AB, Shires GT, Iuner H, et al. Pulmonary acid injury: effects of positive end expiratory pressure and crystalloid versus colloid fluid
resuscitation. Arch Surg 1982;117:662-8.

58. Modell JH. Drowning: current concepts: review article. N Engl J Med 1993;328:253-6.         [ Links ]

59. Edwards ND, Timmins AC, Randalls B, Morgan GAR, Simcock AD. Survival in adults after cardiac arrest due to drowning. Intensive Care Med 1990;16:336-7.         [ Links ]

60. Modell JH. Etiology and treatment of drowning. In: Fletemeyer JR, Freas SJ, editors. New perspectives on intervention and prevention. CRC Press, 1998:21-30.         [ Links ]

61. Kinney EL, Cortada X, Ventura R. Cardiac size and motion during water immersion: implication for volume homeostasis. Am Heart J 1987;113:345-9.         [ Links ]

62. Szpilman D. Position of near-drowning and drowning victim on sloping beaches. Submitted for publication.         [ Links ]

63. Orlowski JP. Drowning, near-drowning, and ice water submmersion. Pediatr Clin North Am 1987;34:92.         [ Links ]

64. Orlowski JP. Drowning, near-drowning and ice-water drowning. JAMA 1988;260:390-1.         [ Links ]

65. Bolte RG, Block PG, Bowers RS, et al. The use of extracorporal rewarming in a child submerged for 66 minutes. JAMA 1988;260:377-9.         [ Links ]

66. Quan L, Kinder D. Pediatric submersions: prehospital predictors of outcome. Pediatrics 1992;90:909-13.         [ Links ]

67. Conn AW, Modell JH. Current neurological considerations in neardrowning (editorial). Can Anaesth Soc J 1980;27:197.         [ Links ]

68. Conn AW, Montes JE, Baker GA, Edmonds JF. Cerebral salvage in near-drowning following neurological classification by triage. Can Anaesth Soc J 1980;27:201-10.         [ Links ]

69. Szpilman D, Amoedo AR, Tomaz N. Atendimento a afogados no Rio de Janeiro: Avaliação de 20 anos do Centro de Recuperação de Afogados. Revista Brasileira de Emergência Pré-hospitalar e Medicina de Desastre 1994;1:19-24.         [ Links ]

70. Modell JH. Drowning: to treat or not to treat? – An unanswerable question” (editorial). Crit Care Med 1993;21:313-5.

71. Lavelle JM, Shaw KN. Near-drowning: is emergency department cardiopulmonary resuscitation or intensive care unit cerebral resuscitation indicated? Crit Care Med 1993;21:368-73.         [ Links ]

72. Vernon DD, Banner W, Cantwell GP, et al: Streptococcus pneumoniae bacteremia associated with near-drowning. Crit Care Med 1990;8: 1175-6.         [ Links ]

73. Allman FD, Nelson WB, Gregory AP, et al. Outcome following cardiopulmonary resuscitation in severe near-drowning. Am J Dis Child 1986;140: 571-5.         [ Links ]

74. Eisemberg MS. Prehospital cardiopulmonary resuscitation: is it effective? JAMA 1985;253:2408-12.         [ Links ]

75. Eisemberg MS, Bergner L, Hallstrom A. Survivors of out of hospital cardiac arrest: morbidity and long time survival. Am J Emerg Med 1984;2:189-92.         [ Links ]

76. Nichter MA, Everett PB. Childhood near-drowning: is cardiopulmonary resuscitation always indicated? Crit Care Med 1989;17:993-5.         [ Links ]

77. Maha RJ, Yealy DM, Menegazzi JJ, Kearns TR, Paris PM. High-dose epinephrine in prehospital cardiac arrest: a preliminary report of 50 cases (abstract). Ann Emerg Med 1990;19:956.         [ Links ]

78. Brown CG, Martin DR, Pepe PE, Stueven H, Cummins RO, Gonzalez E, et al. A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. The Multicenter High-Dose Epinephrine Study Group. N Engl J Med 1992;327:1051-5.         [ Links ]

79. Callaham ML, Madsen CD, Barton CD, Saunders CE, Pointer JA. A randomized clinical trial of high-dose epinephrine and noradrenaline vs. standard dose epinephrine in prehospital cardiac arrest. JAMA 1992;268:2667-72.         [ Links ]

80. Szpilman D, Orlowski JP: In water resuscitation, is it worth? Expanded collected data, Not submitted (Objective: To question the validation to begin the resuscitation process of a drowning victim in the water, taking into consideration the reduction in mortality rate).         [ Links ]

81. Southwick FS, Dalglish PH. Recovery after prolonged asystolic cardiac arrest in profound hypothermia. JAMA 1980;243:1250-3.         [ Links ]

82. Averbach OS, Yajko DM, Nassos OS, et al. Bacteriology of the fresh water environment: implications for clinical therapy. Ann Emerg Med 1987:1016-22.         [ Links ]

83. Bohn DJ, Biggar WD, Smith CR, et al. Influences of hypothermia, barbiturate therapy, and intracranial pressure monitoring on morbidity and mortality after near-drowning. Crit Care Med 1986;14:529-34.         [ Links ]

84. Nussbaum E. Prognostic variables in near-drowned comatose children. Am J Dis Child 1985;139:1058-9.         [ Links ]

85. Sarnaik AP, Preston G, Lieh-Lai M, et al. Intracranial pressure and cerebral perfusion pressure in near-drowning. Crit Care Med 1985;13: 224-7.         [ Links ]

86. Hoff BH. Multisystem failure: a review with special reference to drowning. Crit Care Med 1979;7:310-20.         [ Links ]

87. Ramenofsky ML, Luterman A, Quindlen E, et al. Maximum survival in pediatric trauma: the ideal system. J Trauma 1984;24:818-23.         [ Links ]

88. Karch SB. Pathology of the heart in drowning. Arch Pathol Lab Med 1985;109:176-8.         [ Links ]

89. Szpilman D. Apresentação da estatística do Grupamento Marítimo do Estado do Rio de Janeiro em International Lifesaving Federation Medical- Rescue Conference. San Diego, California, 1997.         [ Links ]

 

 

Endereço para correspondência:
Rua Honestino Guimarães, 11 – Condomínio Maramar
Recreio do Bandeirantes – 22785-390 – Rio de Janeiro, RJ – Brasil
Tel. res.: (21) 490-0192. Tel./fax: (21) 430-7168
E-mail: szpilman@ccard.com.br