A literature review of immersion pulmonary edema

Kumar, Manish; Thompson, Paul D.

doi:10.1080/00913847.2018.1546104

Cited by 20 publications

(24 citation statements)

References 43 publications

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“…It is important to remark that there lacks a standardized definition of this type of pulmonary edema, induced by deep breath-hold diving. In the literature, there are a variety of terms in use, including squeeze ( Lindholm and Lundgren, 2009 ; Schipke et al, 2019 ), pulmonary barotrauma, and immersion pulmonary edema ( Moon et al, 2016 ; Kumar and Thompson, 2019 ). It has been suggested that a pathophysiological link exists between the pulmonary edema occurring during immersion and at high altitude.…”

Section: Discussionmentioning

confidence: 99%

Association Between Arterial Oxygen Saturation and Lung Ultrasound B-Lines After Competitive Deep Breath-Hold Diving

et al. 2021

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Breath-hold diving (freediving) is an underwater sport that is associated with elevated hydrostatic pressure, which has a compressive effect on the lungs that can lead to the development of pulmonary edema. Pulmonary edema reduces oxygen uptake and thereby the recovery from the hypoxia developed during freediving, and increases the risk of hypoxic syncope. We aimed to examine the efficacy of SpO2, via pulse-oximetry, as a tool to detect pulmonary edema by comparing it to lung ultrasound B-line measurements after deep diving. SpO2 and B-lines were collected in 40 freedivers participating in an international deep freediving competition. SpO2 was measured within 17 ± 6 min and lung B-lines using ultrasound within 44 ± 15 min after surfacing. A specific symptoms questionnaire was used during SpO2 measurements. We found a negative correlation between B-line score and minimum SpO2 (rs = −0.491; p = 0.002) and mean SpO2 (rs = −0.335; p = 0.046). B-line scores were positively correlated with depth (rs = 0.408; p = 0.013), confirming that extra-vascular lung water is increased with deeper dives. Compared to dives that were asymptomatic, symptomatic dives had a 27% greater B-line score, and both a lower mean and minimum SpO2 (all p < 0.05). Indeed, a minimum SpO2 ≤ 95% after a deep dive has a positive predictive value of 29% and a negative predictive value of 100% regarding symptoms. We concluded that elevated B-line scores are associated with reduced SpO2 after dives, suggesting that SpO2 via pulse oximetry could be a useful screening tool to detect increased extra-vascular lung water. The practical application is not to diagnose pulmonary edema based on SpO2 – as pulse oximetry is inexact – rather, to utilize it as a tool to determine which divers require further evaluation before returning to deep freediving.

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Section: Discussionmentioning

confidence: 99%

Association Between Arterial Oxygen Saturation and Lung Ultrasound B-Lines After Competitive Deep Breath-Hold Diving

et al. 2021

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“…The first step in the treatment is the immediate removal from the water, providing a warm environment and removal of any constrictive wetsuit. Additional supportive measures in the form of oxygen, diuretics, beta-2 agonists are given depending on the case [1,2,33,34]. Recently, sildenafil and dihydropyridine calcium channel blockers have been used for the prevention of SIPE [14,18].…”

Section: Discussionmentioning

confidence: 99%

“…With an average recurrence rate of 30% and the potential for severe outcome, proper diagnosis and reversal of any underlying pathology in IPE should be done by the physician, before the patient returns to the water activity [12]. Any subject with a history of IPE should undergo detailed and thorough investigations including cardio-pulmonary assessment [34,35].…”

Section: Discussionmentioning

confidence: 99%

Snorkeling Induced Pulmonary Edema: A Case Report and Review of the Literature

Yadav¹,

Kariyanna²,

Jayarangaiah³

et al. 2020

AJMCR

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Swimming-induced pulmonary edema (SIPE), also called immersion pulmonary edema (IPE), is a medical condition seen in various water-based activities such as scuba diving, swimming, aqua jogging, triathlete competition and snorkeling. It occurs when transcapillary filtration of low protein fluid collects in the lungs, in the absence of water aspiration during an aquatic activity, causing acute dyspnea, cough and/or hemoptysis. The hallmark of this entity is the complete resolution of symptoms within 48 hours. SIPE in snorkeling is an underreported and understudied subject. The true prevalence of SIPE is unknown with an estimated range from 1.8-60% among combat swimmers trainee and 1.4% in triathletes. Recent developments have been done in elucidating the pathophysiology of SIPE with regards to pulmonary capillary pressure so that the predisposing factors and potential causes can be targeted. SIPE can be a potentially life-threatening condition, which needs to be recognized by the swimmers, divers, supervising physicians in order to diagnose and manage it promptly. We report a rare case of SIPE in snorkeling which presented with acute respiratory symptoms and managed with supportive measures in the hospital.

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“…With a delicate pulmonary capillary interface (West et al, 1991), it is perhaps not surprising that lung injury can occur, due to the cumulative forces of hydrostatic-induced compression and decompression of both the lungs and thoracic cage, centralization of blood volume, hypertension, exertion, and hypercapnic hypoxia. Such an injury, commonly referred to as lung squeeze, is a form of pulmonary barotrauma that has been extensively reviewed (Ferrigno and Lundgren, 2003;Lindholm and Lundgren, 2009;Dujic and Breskovic, 2012;Mijacika and Dujic, 2016;Moon et al, 2016;Kumar and Thompson, 2019;Schipke et al, 2019). Lung squeeze manifests shortly after surfacing and is characterized by pulmonary edema and hemoptysis (Boussuges et al, 1999;Patrician et al, 2021a), and is often associated with productive cough, dyspnea, and chest tightness (Cialoni et al, 2012); decrements in lung function and reduced oxygen saturation (Linér and Johan, 2008); and an impairment in pulmonary gas efficiency (Patrician et al, 2021a).…”

Section: Risk Of Lung Squeezementioning

confidence: 99%

Breath-Hold Diving – The Physiology of Diving Deep and Returning

et al. 2021

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Breath-hold diving involves highly integrative physiology and extreme responses to both exercise and asphyxia during progressive elevations in hydrostatic pressure. With astonishing depth records exceeding 100 m, and up to 214 m on a single breath, the human capacity for deep breath-hold diving continues to refute expectations. The physiological challenges and responses occurring during a deep dive highlight the coordinated interplay of oxygen conservation, exercise economy, and hyperbaric management. In this review, the physiology of deep diving is portrayed as it occurs across the phases of a dive: the first 20 m; passive descent; maximal depth; ascent; last 10 m, and surfacing. The acute risks of diving (i.e., pulmonary barotrauma, nitrogen narcosis, and decompression sickness) and the potential long-term medical consequences to breath-hold diving are summarized, and an emphasis on future areas of research of this unique field of physiological adaptation are provided.

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A literature review of immersion pulmonary edema

Cited by 20 publications

References 43 publications

Association Between Arterial Oxygen Saturation and Lung Ultrasound B-Lines After Competitive Deep Breath-Hold Diving

Association Between Arterial Oxygen Saturation and Lung Ultrasound B-Lines After Competitive Deep Breath-Hold Diving

Snorkeling Induced Pulmonary Edema: A Case Report and Review of the Literature

Breath-Hold Diving – The Physiology of Diving Deep and Returning

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