Pulmonary Edema Associated With Scuba Diving

Slade, John B; Hattori, Takashi; Ray, C S; Bové, Alfred A.; Cianci, Paul

doi:10.1378/chest.120.5.1686

Cited by 86 publications

(69 citation statements)

References 37 publications

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“…Pulmonary edema, which is not uncommon during higher intensity exercise, immersed or submersed, appears to be due to increased pulmonary blood flow and pressure, resulting in capillary engorgement with increased transmural pressures (94). Pulmonary edema has also been suggested to occur in shallow water breath-hold dives with low lung volume (59), but only in deep dives, compared with shallow dives, when the lungs are inflated (60).…”

Section: Respiratory Functionmentioning

confidence: 99%

The underwater environment: cardiopulmonary, thermal, and energetic demands

Pendergast¹,

Lundgren²

2009

Journal of Applied Physiology

131

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Pendergast DR, Lundgren CE. The underwater environment: cardiopulmonary, thermal, and energetic demands. J Appl Physiol 106: 276 -283, 2009. First published November 26, 2008 doi:10.1152/japplphysiol.90984.2008.-Water covers over 75% of the earth, has a wide variety of depths and temperatures, and holds a great deal of the earth's resources. The challenges of the underwater environment are underappreciated and more short term compared with those of space travel. Immersion in water alters the cardio-endocrine-renal axis as there is an immediate translocation of blood to the heart and a slower autotransfusion of fluid from the cells to the vascular compartment. Both of these changes result in an increase in stroke volume and cardiac output. The stretch of the atrium and transient increase in blood pressure cause both endocrine and autonomic changes, which in the short term return plasma volume to control levels and decrease total peripheral resistance and thus regulate blood pressure. The reduced sympathetic nerve activity has effects on arteriolar resistance, resulting in hyperperfusion of some tissues, which for specific tissues is time dependent. The increased central blood volume results in increased pulmonary artery pressure and a decline in vital capacity. The effect of increased hydrostatic pressure due to the depth of submersion does not affect stroke volume; however, a bradycardia results in decreased cardiac output, which is further reduced during breath holding. Hydrostatic compression, however, leads to elastic loading of the chest wall and negative pressure breathing. The depthdependent increased work of breathing leads to augmented respiratory muscle blood flow. The blood flow is increased to all lung zones with some improvement in the ventilation-perfusion relationship. The cardiac-renal responses are time dependent; however, the increased stroke volume and cardiac output are, during head-out immersion, sustained for at least hours. Changes in water temperature do not affect resting cardiac output; however, maximal cardiac output is reduced, as is peripheral blood flow, which results in reduced maximal exercise performance. In the cold, maximal cardiac output is reduced and skin and muscle are vasoconstricted, resulting in a further reduction in exercise capacity. respiratory; renal; immersion; exercise; aging; sex differences; submersion; pressure; energy cost THE UNDERWATER ENVIRONMENT is unique, and while it is a magical place with great history and beauty and plant and animal life and holds a wealth of resources, it also imposes pronounced physiological stresses on humans and animals. This brief review offers an overview of how the major environmental challenges, i.e., the pressure, temperature extremes, and the unbreathable ambient medium, of the "Silent World" affect circulation, renal system and water balance, breathing, exercise, and thermal balance and how it imposes some threats due to pharmacological or toxic effects of respired gases at high pressure, i.e., great depths. Adaptations to ...

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Section: Respiratory Functionmentioning

confidence: 99%

The underwater environment: cardiopulmonary, thermal, and energetic demands

Pendergast¹,

Lundgren²

2009

Journal of Applied Physiology

131

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“…Immersion pulmonary edema (IPE) is a condition in which cough, hemoptysis, dyspnea, and hypoxemia develop after surface swimming or diving, often in young, healthy individuals (34,45,57,64,96,123), including exceptionally fit military divers (59,64,95,121). It occurs predominantly in males.…”

Section: Pathological Effects Of Divingmentioning

confidence: 99%

Pulmonary gas exchange in diving

Moon

Cherry²,

Stolp³

et al. 2009

Journal of Applied Physiology

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Moon RE, Cherry AD, Stolp BW, Camporesi EM. Pulmonary gas exchange in diving. J Appl Physiol 106: 668 -677, 2009. First published November 13, 2008 doi:10.1152/japplphysiol.91104.2008.-Diving-related pulmonary effects are due mostly to increased gas density, immersion-related increase in pulmonary blood volume, and (usually) a higher inspired PO 2. Higher gas density produces an increase in airways resistance and work of breathing, and a reduced maximum breathing capacity. An additional mechanical load is due to immersion, which can impose a static transrespiratory pressure load as well as a decrease in pulmonary compliance. The combination of resistive and elastic loads is largely responsible for the reduction in ventilation during underwater exercise. Additionally, there is a density-related increase in dead space/tidal volume ratio (VD/VT), possibly due to impairment of intrapulmonary gas phase diffusion and distribution of ventilation. The net result of relative hypoventilation and increased VD/VT is hypercapnia. The effect of high inspired PO 2 and inert gas narcosis on respiratory drive appear to be minimal. Exchange of oxygen by the lung is not impaired, at least up to a gas density of 25 g/l. There are few effects of pressure per se, other than a reduction in the P50 of hemoglobin, probably due to either a conformational change or an effect of inert gas binding. respiratory dead space; ventilation-perfusion ratio; respiratory mechanics DESPITE HAVING EVOLVED in and adapted to an atmosphere with gas density close to 1 g/l, the performance of the human lung in the diving environment is remarkable. Adequate ventilation and gas exchange have been achieved at an ambient pressure up to 71 atmospheres absolute (ATA) [701 m of sea water (msw); 2,310 ft of sea water (fsw)] with an ambient PO 2 of 0.39 ATA (49), and with a PO 2 of 0.2 ATA up to a gas density of 25 g/l (50). Adequate exchange of oxygen and carbon dioxide while diving requires the ability to maintain ventilation in the face of significantly increased resistive and elastic loads. Resistance is increased primarily by the increase in breathing gas density. Elastic load is enhanced primarily by changes in transrespiratory pressure (P TR ). Inertial mechanical load is also increased, although this has a minimal effect on the diver. Added challenges include blunted respiratory drive due to elevated partial pressures of inert gas and oxygen, and possibly impaired diffusion within the alveolus (7). While in most dives the breathing gas is hyperoxic, thus precluding hypoxemia, hypercapnia is common. Hyperoxia, particularly in the venous blood, can induce a small reduction in CO 2 solubility, and hence an increase in venous PCO 2 via the Haldane effect (27,122). Arterial PCO 2 (Pa CO 2 ) is not affected by the Haldane effect because of regulation of breathing via the chemoreceptors, although hypercapnia does occur for other reasons as discussed below.Studies of pulmonary gas exchange under hyperbaric conditions designed to simulate diving have been performed...

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“…This sign of extravascular lung water has been shown to vary on several factors, with depth and effort the most prominent [48]. The oedema usually resolves spontaneously within 24 h, which can be accelerated using β 2 -adrenergic agonist or diuretic therapy [49].…”

Section: Noncardiogenic Oedema and Haemoptysismentioning

confidence: 99%

“…Subclinical cardiopulmonary dysfunction can be exacerbated by immersion and strenuous exercise during diving or swimming, thereby increasing the risk of immersion oedema. In addition, valvular dysfunction and hypertension [54], as well as high airway pressure and obesity [44,49], may augment the likelihood of the development of oedema. MOON et al [19] demonstrated an exaggerated increase in mean pulmonary artery pressure and pulmonary artery wedge pressure in individuals with a history of swimming-induced pulmonary oedema.…”

Section: Individual Susceptibility To Dive-related Lung Injurymentioning

confidence: 99%

Sports-related lung injury during breath-hold diving

Mijačika

Dujić

2016

Eur Respir Rev

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The number of people practising recreational breath-hold diving is constantly growing, thereby increasing the need for knowledge of the acute and chronic effects such a sport could have on the health of participants. Breath-hold diving is potentially dangerous, mainly because of associated extreme environmental factors such as increased hydrostatic pressure, hypoxia, hypercapnia, hypothermia and strenuous exercise.In this article we focus on the effects of breath-hold diving on pulmonary function. Respiratory symptoms have been reported in almost 25% of breath-hold divers after repetitive diving sessions. Acutely, repetitive breath-hold diving may result in increased transpulmonary capillary pressure, leading to noncardiogenic oedema and/or alveolar haemorrhage. Furthermore, during a breath-hold dive, the chest and lungs are compressed by the increasing pressure of water. Rapid changes in lung air volume during descent or ascent can result in a lung injury known as pulmonary barotrauma. Factors that may influence individual susceptibility to breath-hold diving-induced lung injury range from underlying pulmonary or cardiac dysfunction to genetic predisposition.According to the available data, breath-holding does not result in chronic lung injury. However, studies of large populations of breath-hold divers are necessary to firmly exclude long-term lung damage. @ERSpublications Breath-hold diving may result in acute respiratory symptoms, but does not lead to chronic lung dysfunction http://ow.ly/D03r302uMOD

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Pulmonary Edema Associated With Scuba Diving

Cited by 86 publications

References 37 publications

The underwater environment: cardiopulmonary, thermal, and energetic demands

The underwater environment: cardiopulmonary, thermal, and energetic demands

Pulmonary gas exchange in diving

Sports-related lung injury during breath-hold diving

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