Swimming-induced pulmonary edema

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Swimming induced pulmonary edema (SIPE) occurs when fluids from the blood leak abnormally from the small vessels of the lung (pulmonary capillaries) into the airspaces (alveoli).[1]

SIPE usually occurs during heavy exertion in conditions of water immersion, such as swimming and diving. It has been reported in scuba divers,[2][3] apnea (breath hold) free-diving competitors[4][5] combat swimmers,[6][7] and triathletes.[1] The causes are incompletely understood at the present time.[1][8][9]

Signs and symptoms

As with other forms of pulmonary edema, the hallmark of SIPE is cough productive of pink, frothy or blood-tinged sputum. Symptoms include:

Risk factors

Mechanism

The mechanisms by which SIPE occurs are controversial, and likely multiple factors are required for the phenomenon to manifest.[1][8][9]

SIPE is believed to arise from a “perfect storm” of some combination of these factors, which overwhelms the ability of the body to compensate, and leads to alveolar flooding.[1][8][9]

Prevention

With incidence reported to be in the range of 1-2 percent, most (greater than 98%) recreational swimmers do not appear to be at risk for SIPE.[1]

  • Management of hypertension is likely to be important for hypertensive athletes. ACE inhibitors (particularly angiotensin II receptor antagonists) may be effective antihypertensive medications in this setting given their effect on diastolic relaxation, but rationale is theoretical and evidence of SIPE-related benefit is anecdotal.[12][13]
  • Avoidance of excessive pre-swim hydration is advisable[8][9]
  • Nifedipine[8] or sildenafil[14] could theoretically be beneficial due to their ability to modify pulmonary artery pressure, but any use for SIPE is investigational and these agents are not approved for this use.

Management

Management has generally been reported to be conservative, though deaths have been reported.[3]

  • Removal from water[9]
  • Observation[9]
  • Diuretics and / or Oxygen when necessary[8]
  • Episodes are generally self-limiting in the absence of other medical problems [8][9]

Epidemiology

SIPE is estimated to occur in 1-2% of competitive open-water swimmers, with 1.4% of triathletes,[1] 1.8% of combat swimmers[7] and 1.1% of divers and swimmers[2] reported in the literature.

Research

Most of the medical literature on the topic comes from case series in military populations[6][7] and divers,[2][5][10][11] and an epidemiological study in triathletes.[1] A recent experimental study showed increased pulmonary artery pressure with cold water immersion, but this was done in normal subjects rather than in people with a history of SIPE.[15]

References

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  2. 2.0 2.1 2.2 2.3 2.4 2.5 Pons, M; Blickenstorfer, D; Oechslin, E; Hold, G; Greminger, P; Franzeck, UK; Russi, EW (1995). "Pulmonary oedema in healthy persons during scuba-diving and swimming". The European respiratory journal. 8 (5): 762–7. PMID 7656948.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
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  9. 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 Yoder, JA; Viera, AJ (2004). "Management of swimming-induced pulmonary edema". American family physician. 69 (5): 1046, 1048–9. PMID 15023003.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
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