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Immersion Pulmonary Edema

(Swimming-Induced Pulmonary Edema; SIPE)


Richard E. Moon

, MD, Duke University Medical Center

Last full review/revision Jun 2021| Content last modified Jun 2021
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Immersion pulmonary edema is sudden-onset pulmonary edema that typically occurs early during a dive while at depth.

Immersion pulmonary edema has become more widely recognized over the past 2 decades. Immersion pulmonary edema is not related to pulmonary barotrauma Pulmonary Barotrauma Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. Factors increasing risk of pulmonary barotrauma include certain behaviors (eg, rapid ascent, breath-holding... read more or decompression sickness Decompression Sickness Decompression sickness occurs when rapid pressure reduction (eg, during ascent from a dive, exit from a caisson or hyperbaric chamber, or ascent to altitude) causes gas previously dissolved... read more . Instead, in susceptible individuals it involves development of hemodynamic pulmonary edema due to excessively high pulmonary vascular pressures due to blood redistribution from the periphery into the pulmonary vessels. Risk factors include exposure to cold water, a history of hypertension, lung disorders, and other cardiac disorders that involve abnormal left ventricular systolic or diastolic function (including valvular disorders and cardiomyopathy). This syndrome occurs in divers and at the surface in competitive open water swimmers.

Severe dyspnea develops, usually while the diver is at depth. Divers usually ascend rapidly and have cough, frothy sputum, scattered crackles throughout both lung fields, and sometimes cyanosis. Hypoxia Oxygen Desaturation Patients without respiratory disorders who are in the intensive care unit (ICU)—and other patients—may develop hypoxia (oxygen saturation read more Oxygen Desaturation is often present.

Chest x-ray shows typical pulmonary edema. Cardiac evaluation usually shows normal right and left ventricular function and normal coronary arteries, but wall motion abnormalities, valvular dysfunction, and cardiomyopathies have been reported. Diastolic dysfunction can be documented by echocardiography.

Oxygen administration to treat hypoxemia, and sometimes inhaled beta-2 agonists are usually sufficient to allow immersion pulmonary edema to resolve. Diuretics are rarely required. Mechanical ventilation may be necessary for severe cases. Recompression therapy Recompression Therapy Recompression therapy is administration of 100% oxygen for several hours in a sealed chamber pressurized to > 1 atmosphere, gradually lowered to atmospheric pressure. In divers, this therapy... read more is not indicated.

General references

  • 1. Peacher DF, Martina SD, Otteni CE, et al: Immersion pulmonary edema and comorbidities: case series and updated review. Med Sci Sports Exerc, 47(6):1128-34, 2015. PMID: 25222821. doi: 10.1249/MSS.0000000000000524

  • 2. Grünig H, Nikolaidis PT, Moon RE, et al: Diagnosis of swimming induced pulmonary edema: a review. Front Physiol, 8:652, 2017. PMID: 28912730; PMCID: PMC5583207. doi: 10.3389/fphys.2017.00652

  • 3. Hårdstedt M, Seiler C, Kristiansson L, et al: Swimming-induced pulmonary edema: diagnostic criteria validated by lung ultrasound. Chest, 158(4):1586-1595, 2020. Epub 2020 Apr 28. PMID: 32360726. doi: 10.1016/j.chest.2020.04.028


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