To study retrospectively the clinical manifestations and course of near-drowning in sea water. Adult patients who presented to a district hospital with near-drowning, from 11/6/1994 to 1/9/2001. In all 35 patients (24 female, 11 male), aged 18-88 were studied. Of the patients, 28 were elderly (³65 years). Immediately after rescuing at the seaside, 10 of the patients had a GCS <9 and 6 had a GCS of 9-14. At presentation, 7 patients had a GCS <15 and two of them were still comatose and had to be intubated for airway protection. Α third patient had to be intubated within the first 24 hours, because of ARDS. In all, 4 patients had to be transferred to an ICU - 2 of them because of coma and 2 because of acute respiratory failure. Of the comatose patients, one died because of ventilator-associated pneumonia. No other fatalities were observed. All patients, with two exceptions, had a PaO2/FiO2 <300 at presentation. Criteria of ARDS were fulfilled in 14 and criteria of ALI (acute lung injury) in 12 cases. Superimposed pneumonia was observed in 4 patients (one intubated). Improvement of arterial blood gases was rapid in most cases and 24 hours after presentation, only 6 patients still had ARDS. A worsening of gas exchange after the first day was observed in 2 cases. Duration of hospitalization varied from 2 tο 11 days (5,23±0,47 days, mean±SEM). Duration of hospital stay was significantly longer in patients who presented with GCS <15 (7,57±0,78 vs 4±0,79 days, p=0,023). In the absence of serious neurologic impairement, near drowning victims, even when they are elderly, can be expected to have a good outcome, despite the frequent presence of severe acute respiratory failure. Pneumon 2004, 17(1):72-79.