Quality Review
Meet the Q&PS Team
MedicASK Answers
MedicASK Answers Full List
Patient Safety Incident Report
Loss or theft of controlled substances
MedicASK
Files
CPAP in Pediatric Drowning
Question# 979
Do you think it is worthwhile for paramedics to patch to a BHP to discuss using CPAP on <18 y/o patients with pulmonary edema secondary to drowning?
Sub questions: Is it the right thing to do? What modifications to our standard pressures/procedures should we make? Will your colleagues be likely to endorse it on a patch?
I am aware that our CPAP device (https://otwo.com/single-use-cpap/) is compatible with our peds BVM masks and with common peds BiPAP starting pressures so I believe this could be a reality, with your guidance.
Sub questions: Is it the right thing to do? What modifications to our standard pressures/procedures should we make? Will your colleagues be likely to endorse it on a patch?
I am aware that our CPAP device (https://otwo.com/single-use-cpap/) is compatible with our peds BVM masks and with common peds BiPAP starting pressures so I believe this could be a reality, with your guidance.
Answer:
While there are no randomized controlled trials evaluating ventilation strategies in non-fatal drowning patients there is some observational data, case reports, and a strong physiological rationale that supports that use of CPAP in this population.
In non-fatal drowning where there is a significant aspiration event the combined effects of fluid in the lungs, surfactant washout, and increased capillary-alveolar permeability result in non-cardiogenic pulmonary edema that is amenable to positive pressure ventilation.
There are several observational studies that report improved outcomes in drowning patients, including children, where NIPPV is the primary approach in spontaneously breathing AND conscious patients.
The guidelines that most explicitly speak to NIPPV in drowning patients come from Wilderness Medical Society (2024) which recommend the use of NIPPV (CPAP in our case) ONLY in alert drowning patients who have intact airway reflexes and are able to cooperate. The guidelines recommend caution in patients with altered mental status due to increased risks of vomiting and aspiration.
In general, the RPPEO supports the application of the CPAP medical directive in adults to non-cardiogenic causes of pulmonary edema, this would include in drownings.
In the case of a child a patch would be required and would be a collaborative decision between the paramedic and the BHP however there is a strong case to be made for the utility of CPAP in this context.
With regards to the CPAP mask size, equipment should not be modified to be used in a way other than intended by the manufacturer. If the CPAP mask is not a suitable fit for the patient (adult or child) then the intervention should not be applied.
In non-fatal drowning where there is a significant aspiration event the combined effects of fluid in the lungs, surfactant washout, and increased capillary-alveolar permeability result in non-cardiogenic pulmonary edema that is amenable to positive pressure ventilation.
There are several observational studies that report improved outcomes in drowning patients, including children, where NIPPV is the primary approach in spontaneously breathing AND conscious patients.
The guidelines that most explicitly speak to NIPPV in drowning patients come from Wilderness Medical Society (2024) which recommend the use of NIPPV (CPAP in our case) ONLY in alert drowning patients who have intact airway reflexes and are able to cooperate. The guidelines recommend caution in patients with altered mental status due to increased risks of vomiting and aspiration.
In general, the RPPEO supports the application of the CPAP medical directive in adults to non-cardiogenic causes of pulmonary edema, this would include in drownings.
In the case of a child a patch would be required and would be a collaborative decision between the paramedic and the BHP however there is a strong case to be made for the utility of CPAP in this context.
With regards to the CPAP mask size, equipment should not be modified to be used in a way other than intended by the manufacturer. If the CPAP mask is not a suitable fit for the patient (adult or child) then the intervention should not be applied.