drowning-related acute respiratory failure

Conditions: Drowning

Summary: the purpose of this study is to assess the non-invasive ventilation-continuous positive airway pressure efficacy (experimental group) for drowning related acute respiratory failure compared to oxygen supply by face mask (15liters/minutes) (control group).

open-label, multicenter, prospective, cross-over cluster randomized (ratio 1:1), conducted in 16 emergency medical service centers in france : * experimental group: non-invasive ventilation-continuous positive airway pressure (arm 1) * control group: oxygen supply by face mask (arm 2) drowning-related acute respiratory failure has important clinical consequences (4 to 18% mortality). no national/international medical consensus exist for its management. our team has successively demonstrated that: * the acute respiratory failure related to drowning in salt or fresh water presented the same clinical pathway and prognosis ; * most victims with drowning related acute respiratory failure do no present hemodynamic instability ; * if the oxygenation is rapidly improved, neurological status is also maintained in acute respiratory failure victims ; * pediatric and adult presentations are similar. facing an acute respiratory failure, emergency medical service must rapidly choose between oxygen supply by face mask (15 liters /minutes), mechanical ventilation or non-invasive ventilation. mechanical ventilation as non-invasive ventilation present interests and side arms. no comparative study has been conducted between these strategies. the arguments for non-invasive ventilation use specifically in a continuous positive airway pressure mode are: * fast recovery of acute respiratory failure in 24h * retrospective publications showing that the benefit of non-invasive ventilation probably based on continuous positive airway pressure mode * easy implementation of continuous positive airway pressure in the pre-hospital setting (adults, children, newborns) * complexity of mechanical ventilation in pre-hospital setting. our working hypothesis is the efficacy of early use of non-invasive ventilation-continuous positive airway pressure in drowning related acute respiratory failure.

Eligibility criteria:
inclusion criteria: * man/boy or woman/girl, 1yo and older. * subject suffering from drowning related-acute respiratory failure (whatever the nature of water, salt or fresh) and benefiting from the emergency medical service intervention; * acute respiratory failure defined as the presence of: * capillary o2 saturation \<92% upon emergency medical service first clinical analysis at the drowning scene; * need for oxygen supply 15liters/minutes to reach capillary o2 saturation ≥ 95%; * combination of acute respiratory failure clinical signs: at least 1 of the following items: respiratory rate \>30/min, sternal or clavicular indrawing, abdominal breathing, cyanosis. * individual affiliated to or beneficiary of a french health insurance system; * individual with the ability to benefit from the two strategies (ambivalence clause); * adult individual having signed written informed consent or child subject with an authorization of the parents. exclusion criteria: * individual with hypothermia ≤ 34°c ; * individual with neurological distress defined by a glasgow coma scale \< 13 at first clinical assessment and during the first 15 minutes of care ; * individual with hemodynamic distress defined by a systolic blood tension \< 90 mmhg at first clinical assessment and during the first 15 minutes of care ; * cardiac arrest or respiratory arrest ; * declared pregnancy or breastfeeding ; * patient under legal protection regime for adults.