Pulmonary Oedema of Immersion
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Pulmonary Oedema of Immersion Michael S. Koehle,1,2,3 Michael Lepawsky2 and Donald C. McKenzie1,2,3 1 2 3
Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada School of Human Kinetics, University of British Columbia, Vancouver, British Columbia, Canada
Abstract
Acute pulmonary oedema has been described in individuals participating in three aquatic activities: (i) scuba diving; (ii) breath-hold diving; and (iii) endurance swimming. In this review, 60 published cases have been compiled for comparison. Variables considered included: age; past medical history; activity; water depth, type (salt or fresh) and temperature; clinical presentation; investigations; management; and outcome. From these data, we conclude that a similar phenomenon is occurring among scuba, breath-hold divers and swimmers. The pathophysiology is likely a pulmonary overperfusion mechanism. High pulmonary capillary pressures lead to extravasation of fluid into the interstitium. This overperfusion is caused by the increase in ambient pressure, peripheral vasoconstriction from ambient cold, and increased pulmonary blood flow resulting from exercise. Affected individuals are typically healthy males and females. Older individuals may be at higher risk. The most common symptoms are cough and dyspnoea, with haemoptysis also a frequent occurrence. Chest pain has never been reported. Radiography is the investigation of choice, demonstrating typical findings for pulmonary oedema. Management is supportive, with oxygen the mainstay of treatment. Cases usually resolve within 24 hours. In some cases, diuretics have been used, but there are no data as to their efficacy. Nifedipine has been used to prevent recurrence, but there is only anecdotal evidence to support its use.
Pulmonary oedema following scuba diving in previously healthy individuals is a rare occurrence that has been reported in the literature with increasing frequency in recent years.[1-10] An analogous phenomenon has also been reported in breath-hold divers[5,11-14] and endurance swimmers.[9,15-18] The similarities present between these entities are extensive and bear analysis. In this review, we have compiled the reported cases of idiopathic pulmonary oedema resulting from these activities and profiled
them to help improve understanding of this condition. 1. Methods PubMed/Medline and MDConsult databases were searched by combining the keywords ‘scuba’, ‘diving’ or ‘swimming’ with ‘pulmonary oedema’. The entire date ranges of these databases were searched through August 2003. Bibliographies of articles selected were used to find additional pertinent references. Preference was given to primary
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references, including surveys, case series and original research. The search was not limited to articles in the English language. A total of 20 articles and abstracts met these
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