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Immersion Pulmonary Edema

By Alfred A. Bove, MD, PhD, Professor (Emeritus) of Medicine, Lewis Katz School of Medicine, Temple University

Immersion pulmonary edema is sudden development of fluid in the lungs that typically occurs early during a dive and at depth.

Immersion pulmonary edema has become more common over the past two decades. It usually occurs in competitive open-water swimmers. A likely cause of the disorder is changes in pressure in the chest cavity that make it difficult to expand the lungs. As a result, the person needs to suck in forcefully in order to breathe. Immersion pulmonary edema is not related to lung barotrauma or decompression sickness. Cold water and a history of high blood pressure are risk factors.

Divers usually ascend rapidly and become very short of breath. A cough with frothy sputum is typical and blood oxygen levels are low.

Doctors may do tests such as chest x-rays and echocardiography to confirm the diagnosis.

Treatment includes diuretics, such as intravenous furosemide, and oxygen, usually given under pressure by a mask. Mechanical ventilation may be necessary. Recompression therapy is not given.

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