Occurrence, Risk Factors, Prognosis and Prevention of Swimming-Induced Pulmonary Oedema: a Systematic Review

Abstract

BackgroundSwimming-induced pulmonary oedema (SIPE) can affect people with no underlying health problems, but may be life threatening and is poorly understood. The aim of this systematic review was to synthesise the evidence on SIPE incidence, prevalence, risk factors, short- and long-term outcomes, recurrence and effectiveness of interventions to prevent recurrences.MethodsWe carried out a literature search using bibliographic databases and reference lists. Risk of bias was assessed by adapting existing quality assessment tools including those developed by the National Heart Lung and Blood Institute.ResultsNine studies met the inclusion criteria. Quantitative synthesis was not possible because of study heterogeneity. Five studies, which differed from each other in case definition, swimming environment, population characteristics and denominators, reported an incidence of 0.01% of UK triathlons raced over 5 years in unspecified swimming environments (one study, not fully reported, of men and women of unspecified age); 0.5% of river races swum over 3 days in Sweden (one study, of men and women up to the age of 70); and 1.8–26.7% of time trials in the sea around Israel (three studies of male teenage military trainees). One study reported that 1.4% of triathletes in the USA had experienced SIPE. One study found that hypertension, female sex, fish oil use, long course distance and another lower initial lung volumes and flows were risk factors for SIPE. A third study reported that higher mean pulmonary artery pressures and pulmonary artery wedge pressures, and lower tidal volumes were associated with SIPE. Three studies suggested that SIPE symptoms usually resolve within 24 h, although a restrictive deficit in lung function persisted for a week in one small study. We found no studies that reported deaths from SIPE. The single small study of longer-term outcomes reported no difference between affected and unaffected swimmers. Two studies suggested that around 30% of people report recurrences of SIPE. Two very small uncontrolled studies of the effect of sildenafil for recurrence prevention were inconclusive.ConclusionsSIPE may be an important public health problem affecting the growing number of recreational open water swimmers. Further research should clarify the frequency of SIPE among recreational open water swimmers, confirm reported risk factors and explore others, explore long-term consequences and test interventions to prevent recurrences.Electronic supplementary materialThe online version of this article (10.1186/s40798-018-0158-8) contains supplementary material, which is available to authorized users.

Immersion pulmonary edema in a patient on maintenance dialysis: A case report

“…The rapid resolution of signs and symptoms of pulmonary edema in this case is consistent with previous reports on IPE in healthy individuals or athletes . Unlike other causes of pulmonary edema, such as acute coronary syndrome and ARDS that require treatment over a long period of time, IPE resolves relatively quickly as patients become free from the underwater environment that promotes the development of pulmonary edema. Moreover, the fast recovery in this case was probably possible because excess fluid removal was carried out by renal replacement therapy using his arteriovenous shunt.…”

“…Other strong contributing factors that increased the risk of IPE include his hypertension, which could increase afterload, and his impaired left ventricular motion, which could increase pulmonary capillary pressure. 10,11 To the best of our knowledge, this is the first case report on IPE in a patient on maintenance dialysis. The scarcity of case report in this patient population is likely attributed to that very few patients on dialysis attempt diving or this condition is under-recognized or under-reported.…”

“…Indeed, after the discharge, this patient was followed up in a nearby clinic and eventually referred to a different hospital to undergo valve replacement surgery for aortic stenosis. Other strong contributing factors that increased the risk of IPE include his hypertension, which could increase afterload, and his impaired left ventricular motion, which could increase pulmonary capillary pressure …”

Mortes na Natação de Águas Abertas, por quê?

“…Água fria, exercício, elevada pressão inspiratória e estresse emocional são fatores de risco (11). Um estudo de revisão demonstrou que as ocorrências em provas de natação de águas abertas pode ser um problema de saúde pública, pois, envolve a participação de centenas de participantes e, frequentemente são subnotificadas, sendo necessário um maior conhecimento e controle dos fatores de risco (12).…”

Swimming-Induced Pulmonary Edema

“…4,5,9 With the rising popularity of open water swimming among recreational swimmers as well as professional athletes, increased knowledge on SIPE is crucial. 8,[11][12][13][14] To evaluate diagnostic criteria for SIPE, we studied 160 swimmers with respiratory symptoms in a large cohort of 17,904 individuals participating in Sweden's largest annual open water event. Our aim was to identify easily assessed clinical criteria based on physical examination and presentation of symptoms.…”