Immersion pulmonary edema

Revision as of 14:47, 22 March 2016 by Ostermayer (talk | contribs) (Text replacement - "Category:Environ" to "Category:Environmental")

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 approx 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

Diagnosis

Work-up

  • CXR
  • CBC, BMP
  • May consider ABG

Evaluation

  • Clinical diagnosis, based on history and physical examination

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

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.