Sports Medicine

, Volume 35, Issue 3, pp 183–190 | Cite as

Pulmonary Oedema of Immersion

  • Michael S. Koehle
  • Michael Lepawsky
  • Donald C. McKenzie
Leading Article

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.

Notes

Acknowledgements

Dr Koehle was supported by the National Sciences and Engineering Research Council and the British Columbia Sports Medicine Research Foundation. No potential conflicts of interest exist.

References

  1. 1.
    Cosgrove H, Guly H. Acute shortness of breath: an unusual cause. J Accid Emerg Med 1996; 13 (5): 356–7PubMedCrossRefGoogle Scholar
  2. 2.
    Gnadinger CA, Colwell CB, Knaut AL. Scuba diving-induced pulmonary edema in a swimming pool. J Emerg Med 2001; 21 (4): 419–21PubMedCrossRefGoogle Scholar
  3. 3.
    Halpern P, Gefen A, Sorkine P, et al. Pulmonary oedema in SCUBA divers: pathophysiology and computed risk analysis. Eur J Emerg Med 2003; 10 (1): 35–41PubMedCrossRefGoogle Scholar
  4. 4.
    Hampson NB, Dunford RG. Pulmonary edema of scuba divers. Undersea Hyperb Med 1997; 24 (1): 29–33PubMedGoogle Scholar
  5. 5.
    Pons M, Blickenstorfer D, Oechslin E, et al. Pulmonary oedema in healthy persons during scuba-diving and swimming. Eur Respir J 1995; 8 (5): 762–7PubMedGoogle Scholar
  6. 6.
    Slade Jr JB, Hattori T, Ray CS, et al. Pulmonary edema associated with scuba diving: case reports and review. Chest 2001; 120 (5): 1686–94PubMedCrossRefGoogle Scholar
  7. 7.
    Wilmshurst P. Cardiovascular problems in divers. Heart 1998; 80 (6): 537–8PubMedGoogle Scholar
  8. 8.
    Wilmshurst P, Nuri M, Crowther A, et al. Forearm vascular responses in subjects who develop recurrent pulmonary oedema when scuba diving: a new syndrome [abstract]. Br Heart J 1981; 45: 349Google Scholar
  9. 9.
    Wilmshurst PT, Nuri M, Crowther A, et al. Cold-induced pulmonary oedema in scuba divers and swimmers and subsequent development of hypertension. Lancet 1989; I (8629): 62–5CrossRefGoogle Scholar
  10. 10.
    Wilmshurst P. Analysis of decompression accidents in amateur divers. Prog Underwater Sci 1990; 15: 31–7Google Scholar
  11. 11.
    Boussuges A, Succo E, Bergmann E, et al. Intra-alveolar hemorrhage: an uncommon accident in a breath holding diver [in French]. Presse Med 1995; 24 (25): 1169–70PubMedGoogle Scholar
  12. 12.
    Boussuges A, Pinet C, Thomas P, et al. Haemoptysis after breath-hold diving. Eur Respir J 1999; 13 (3): 697–9PubMedCrossRefGoogle Scholar
  13. 13.
    Kiyan E, Aktas S, Toklu AS. Hemoptysis provoked by voluntary diaphragmatic contractions in breath-hold divers. Chest 2001; 120 (6): 2098–100PubMedCrossRefGoogle Scholar
  14. 14.
    Strauss MB, Wright PW. Thoracic squeeze diving casualty. Aerosp Med 1971; 42 (6): 673–5PubMedGoogle Scholar
  15. 15.
    Lund KL, Mahon RT, Tanen DA, et al. Swimming-induced pulmonary edema. Ann Emerg Med 2003; 41 (2): 251–6PubMedCrossRefGoogle Scholar
  16. 16.
    Mahon RT, Kerr S, Amundson D, et al. Immersion pulmonary edema in special forces combat swimmers. Chest 2002; 122 (1): 383–4PubMedCrossRefGoogle Scholar
  17. 17.
    Shupak A, Weiler-Ravell D, Adir Y, et al. Pulmonary oedema induced by strenuous swimming: a field study. Respir Physiol 2000; 121 (1): 25–31PubMedCrossRefGoogle Scholar
  18. 18.
    Weiler-Ravell D, Shupak A, Goldenberg I, et al. Pulmonary oedema and haemoptysis induced by strenuous swimming. BMJ 1995; 311 (7001): 361–2PubMedCrossRefGoogle Scholar
  19. 19.
    Khan MY. Fatal thoracic squeeze. J Indian Med Assoc 1979; 73 (2): 38–9PubMedGoogle Scholar
  20. 20.
    Arborelius Jr JM, Balldin UI, Lilja B, et al. Hemodynamic changes in man during immersion with head above water. Aerosp Med 1972; 43 (7): 592–8PubMedGoogle Scholar
  21. 21.
    Keatinge WR, McIlroy MB, Goldfien A. Cardiovascular responses to ice-cold showers. J Appl Physiol 1964; 19 (6): 1145–50PubMedGoogle Scholar
  22. 22.
    West JB, Tsukimoto K, Mathieu-Costello O, et al. Stress failure in pulmonary capillaries. J Appl Physiol 1991; 70 (4): 1731–42PubMedGoogle Scholar
  23. 23.
    Marshall BE, Teichner RL, Kallos T, et al. Effects of posture and exercise on the pulmonary extravascular water volume in man. J Appl Physiol 1971; 31 (3): 375–9PubMedGoogle Scholar
  24. 24.
    Caillaud C, Serre-Cousine O, Anselme F, et al. Computerized tomography and pulmonary diffusing capacity in highly trained athletes after performing a triathlon. J Appl Physiol 1995; 76 (4): 1226–32Google Scholar
  25. 25.
    Thorsen E, Skogstad M, Reed JW. Subacute effects of inspiratory resistive loading and head-out water immersion on pulmonary function. Undersea Hyperb Med 1999; 26 (3): 137–41PubMedGoogle Scholar
  26. 26.
    Australian Sports Commission. Active Australia: the numbers game [online]. Available from URL: http://www.activeaustralia.org/facts/scubadiving.pdf [Accessed 2003 Aug 20]
  27. 27.
    Koehle M, Lloyd-Smith R, McKenzie D, et al. Asthma and recreational SCUBA diving: a systematic review. Sports Med 2003; 33 (2): 109–16PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Michael S. Koehle
    • 1
    • 2
    • 3
  • Michael Lepawsky
    • 2
  • Donald C. McKenzie
    • 1
    • 2
    • 3
  1. 1.Allan McGavin Sports Medicine CentreUniversity of British ColumbiaVancouverCanada
  2. 2.Department of Family PracticeUniversity of British ColumbiaVancouverCanada
  3. 3.School of Human KineticsUniversity of British ColumbiaVancouverCanada

Personalised recommendations