PEDIATRICS Vol. 81 No. 5 May 1988, pp. 630-634
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Pentobarbital Therapy Does Not Improve Neurologic Outcome in Nearly Drowned, Flaccid-Comatose Children

Eliezer Nussbaum MD1 and J. Carlos Maggi MD1

1 From the Pediatric Critical Care Center, Miller Children's Hospital of Long Beach, and the Department of Pediatrics, University of California, Irvine

The effect of pentobarbital therapy was studied prospectively in 31 nearly drowned children in a flaccid state of coma. Each child was assigned to one of two sequential treatment groups. Group A: 16 children were treated with hypothermia and IV pentobarbital, achieving serum levels >25 µ/mL within 48 hours of admission. Group B: 15 children were treated with hypothermia but no pentobarbital. All patients received "conventional therapy" (ie, Paco2 20 to 25 mm Hg, Pao2 90 to 100 mm Hg, fluid restriction, pancuronium bromide, and furosemide or mannitol). Analysis of variance failed to detect differences for age, estimated time of submersion, arterial pH, core temperature, and mean intracranial pressure between the patients prior to treatment with pentobarbital. In Group A, six patients (37%) recovered completely and were neurologically intact, six patients (37%) had severe brain damage and four patients (26%) died. In Group B, six patients (40%) recovered completely, six patients (40%) survived with brain damage, and three patients (20%) died. There were no statistical differences between the two groups (P > .05, khgr2 analysis) for the mortality rate, survival with brain damage, and complete recovery. The results suggest that: (1) pentobarbital therapy does not improve neurologic outcome for nearly drowned, flaccid-comatose children; (2) previous claims implying better outcome with hypothermia combined with pentobarbital therapy may be attributed to the effect of hypothermia alone; and (3) pentobarbital therapy may not be justified in nearly drowned, flaccid-comatose victims.

Key Words: pentobarbital • near-drowning • coma

Submitted on March 30, 1987
Accepted on December 23, 1987




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