Early pronation, protective lung ventilation and use of awake-prone-HFNO therapy after extubation in near-fatal drowning

the lack of comparative studies and of multicenter trials still makes the treatment of the lung injured drowned patient a challenge for intensivists. Although the outcome of drowned patients is related to the potential neurological sequalae, AHRF remains the main concern. Ventilation guidelines for drowning patients are mainly adapted from AHRF patients and may not reflect the needs of this particular population. Our result confirms that early pronation, in cases of lack of improvement of oxygenation, might be the correct strategy.14 In addition, HFNO and awake prone position might have a role in avoiding reintubation while maintaining adequate pulmonary gas exchanges.

The eye may be the spy of injury related to NIV interface and prone positioning.