Difference between revisions of "Immersion pulmonary edema"

(Management)
 
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==Clinical Features<ref name="Ludwig">Ludwig BB, Mahon RT, Schwartzman EL. Cardiopulmonary function after recovery from swimming-induced pulmonary edema. Clin J Sport Med. 2006 Jul;16(4):348-51.</ref>==
 
==Clinical Features<ref name="Ludwig">Ludwig BB, Mahon RT, Schwartzman EL. Cardiopulmonary function after recovery from swimming-induced pulmonary edema. Clin J Sport Med. 2006 Jul;16(4):348-51.</ref>==
*Cough, dyspnea and/or hemoptysis immediately after water immersion
+
*[[Cough]], [[dyspnea]] and/or [[hemoptysis]] immediately after water immersion
 
*No history of water aspiration or laryngospasm
 
*No history of water aspiration or laryngospasm
*Hypoxia (SpO2 <92% or A-a gradient >30)
+
*[[Hypoxia]] (SpO2 <92% or A-a gradient >30)
 
*[[CXR]] opacities consistent with interstitial pulmonary edema or alveolar filling process
 
*[[CXR]] opacities consistent with interstitial pulmonary edema or alveolar filling process
  
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==Evaluation==
 
==Evaluation==
===Work-up===
+
*Clinical diagnosis, based on history and physical examination
 
*[[CXR]]
 
*[[CXR]]
 +
**opacities consistent with interstitial pulmonary edema or alveolar filling process
 
*CBC, BMP
 
*CBC, BMP
*May consider ABG
+
*May consider [[ABG]]
 
 
===Evaluation===
 
*Clinical diagnosis, based on history and physical examination
 
  
 
==Management==
 
==Management==
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**[[Albuterol]] may be used for symptomatic relief
 
**[[Albuterol]] may be used for symptomatic relief
 
*Typically resolves completely within 24-48 hours
 
*Typically resolves completely within 24-48 hours
*Sildenafil may prevent progression of pulmonary edema<ref>Moon RE et al. Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. Circulation. 2016; CIRCULATIONAHA.115.019464.</ref>
+
*[[Sildenafil]] may prevent progression of pulmonary edema<ref>Moon RE et al. Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. Circulation. 2016; CIRCULATIONAHA.115.019464.</ref>
 
**Dosing uncertain, consider that the half-life is 4 hours
 
**Dosing uncertain, consider that the half-life is 4 hours
  

Latest revision as of 19:22, 28 September 2019

Background

  • Also known as Swimming-Induced Pulmonary Edema (SIPE)[1]
  • Populations affected: Combat swimmers (e.g. Navy SEALs), triathletes, and submersion divers (aka "breath-hold diving")[2]
    • Prevalence approximately 1.8% in combat swimmers
    • Very rare outside these groups
    • Similar to exertion-related pulmonary edema (best described in racehorses)
  • No good evidence-based risk factors identified, but hypertension appears to be associated[2]
    • There may also be some relation to overhydration.[3]
  • Immersion increases cardiac output and doubles pulmonary artery pressures compared to being out of water[2]
    • Blood is also redistributed from extremities to the thorax. This effect is greater in cold water.[4]

Clinical Features[4]

  • Cough, dyspnea and/or hemoptysis immediately after water immersion
  • No history of water aspiration or laryngospasm
  • Hypoxia (SpO2 <92% or A-a gradient >30)
  • CXR opacities consistent with interstitial pulmonary edema or alveolar filling process

Differential Diagnosis

Water-related injuries

Evaluation

  • Clinical diagnosis, based on history and physical examination
  • CXR
    • opacities consistent with interstitial pulmonary edema or alveolar filling process
  • CBC, BMP
  • May consider ABG

Management

  • Primarily supportive care, including supplemental oxygen[3][5]
    • Remove from water
    • Remove cold clothes and place into a warm environment
    • Albuterol may be used for symptomatic relief
  • Typically resolves completely within 24-48 hours
  • Sildenafil may prevent progression of pulmonary edema[6]
    • Dosing uncertain, consider that the half-life is 4 hours

Disposition

  • Discharge if asymptomatic or minimal symptoms, normal SpO2
  • Otherwise, admit for observation

See Also

References

  1. https://clinicaltrials.gov/ct2/show/NCT00815646 (Accessed 08/17/15)
  2. 2.0 2.1 2.2 Miller CC 3rd, Calder-Becker K, Modave F. Swimming-induced pulmonary edema in triathletes. Am J Emerg Med. 2010 Oct;28(8):941-6.
  3. 3.0 3.1 Yoder JA, Viera AJ. Management of swimming-induced pulmonary edema. Am Fam Physician. 2004 Mar 1;69(5):1046, 1048-9.
  4. 4.0 4.1 Ludwig BB, Mahon RT, Schwartzman EL. Cardiopulmonary function after recovery from swimming-induced pulmonary edema. Clin J Sport Med. 2006 Jul;16(4):348-51.
  5. Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med. 2003 Feb;41(2):251-6.
  6. Moon RE et al. Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. Circulation. 2016; CIRCULATIONAHA.115.019464.