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Immersion pulmonary edema
From WikEM
Contents
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
- Immersion pulmonary edema
- Submersion injury (drowning and near-drowning)
- Scuba diving emergencies
- Lightning injuries
- Hypothermia
- Marine toxins and envenomations
- Spinal cord trauma
Evaluation
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
- 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
- ↑ https://clinicaltrials.gov/ct2/show/NCT00815646 (Accessed 08/17/15)
- ↑ 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.
- ↑ 3.0 3.1 Yoder JA, Viera AJ. Management of swimming-induced pulmonary edema. Am Fam Physician. 2004 Mar 1;69(5):1046, 1048-9.
- ↑ 4.0 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.
- ↑ Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med. 2003 Feb;41(2):251-6.
- ↑ Moon RE et al. Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. Circulation. 2016; CIRCULATIONAHA.115.019464.
Authors
Michael Holtz, Kevin Lu, Ross Donaldson, Daniel Ostermayer, Neil Young
