Pathophysiological Aspects of Drowning: A Narrative Review

Abstract

Drowning remains one of the main causes of unintentional death in Brazil, especially in children, adolescents and young adults, and in several parts of the world, with significant implications for public health. Objective: This article presents a narrative review of the literature published between 2000 and 2025, describing the main occurrence, cardiovascular, neurological and thermal mechanisms involved in drowning. Methodology: The PubMed, Scopus, Web of Science, SciELO, LILACS and BVS databases were consulted. After a two-stage screening process, 72 references met all eligibility criteria and composed the final synthesis. Drowning is classified as the process of aspiration of non-body fluid, usually water, during an episode of submersion or trance. Respiratory changes include airway obstruction, pulmonary edema and hypoxemia, which can lead to acute distress syndrome (ARDS) in severe cases. Cardiovascular changes include arrhythmias, bradycardia, hypotension and shock, which may be precipitated by hydrocution (thermal shock), especially in cold-water drowning. The neurological impact is substantial and can range from mild cognitive deficits to irreversible brain damage, depending on the time of submersion and the immediate therapeutic response. Current statistics reveal that Brazil recorded 5,883 deaths by drowning in 2023, with the highest mortality rate affecting children and young people, mainly in the age groups of 1 to 4 years (2nd cause) and 10 to 14 years (3rd cause), 5 to 9 years (4th cause) and 15 to 24 years (4th cause). These numbers reflect the urgent need for improvements in public prevention policies and in the training of health and rescue professionals. It is concluded that a detailed understanding of the pathophysiological mechanisms of drowning is essential for the development of more effective prevention, rescue and clinical management strategies, in addition to reinforcing the importance of education and public awareness to reduce mortality and sequelae associated with this type of accident in Brazil.