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Swimming-induced pulmonary edema
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Swimming-induced pulmonary edema
Swimming induced pulmonary edema (SIPE), also known as immersion pulmonary edema, is a life threatening condition that occurs when fluids from the blood leak abnormally from the small vessels of the lung (pulmonary capillaries) into the airspaces (alveoli).
SIPE usually occurs during exertion in conditions of water immersion, such as swimming and diving. With the recent surge in popularity of triathlons and swimming in open water events there has been an increasing incidence of SIPE. It has been reported in scuba divers, apnea (breath hold) free-diving competitors, combat swimmers, and triathletes. The causes are incompletely understood as of 2010. Some authors believe that SIPE may be the leading cause of death among recreational scuba divers, but there is insufficient evidence at present.
As with other forms of pulmonary edema, the hallmark of SIPE is a cough which may lead to frothy or blood-tinged sputum. Symptoms include:
It has been described in scuba divers, long-distance swimmers, and breath-hold divers.
Immersion causes increased external hydrostatic pressure, leading to redistribution of blood from the periphery to the chest, which increases cardiac filling pressures and stroke volume, and also reduces total lung capacity. There is a movement of fluid from the alveolar capillaries into the alveoli and extravascular lung tissues, which increases with time, and is normal in healthy humans when immersed. This is normally counteracted by the release of BNP which causes sodium and water excretion through the kidneys. This natriuresis is slow, so lung water increase is to some extent normal, but in susceptible people a higher rate of accumulation produces symptoms of SIPE
The alveoli of the lungs fill with edema fluid, causing dyspnoea, cough and frothy or bloodstained sputum. Gas exchange is affected, and as hypoxia increases there may be a loss of consciousness. Oxygenation in divers may be affected by breathing gas mix and partial pressure reduction due to ascent. In severe cases hypoxia may cause cardiac arrest and death. Research continues into the various factors causing IPO.
Possible aggravating factors include:
SIPE is believed to arise from some combinations of these factors, which overwhelms the ability of the body to compensate, and leads to alveolar flooding.
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Swimming-induced pulmonary edema
Swimming induced pulmonary edema (SIPE), also known as immersion pulmonary edema, is a life threatening condition that occurs when fluids from the blood leak abnormally from the small vessels of the lung (pulmonary capillaries) into the airspaces (alveoli).
SIPE usually occurs during exertion in conditions of water immersion, such as swimming and diving. With the recent surge in popularity of triathlons and swimming in open water events there has been an increasing incidence of SIPE. It has been reported in scuba divers, apnea (breath hold) free-diving competitors, combat swimmers, and triathletes. The causes are incompletely understood as of 2010. Some authors believe that SIPE may be the leading cause of death among recreational scuba divers, but there is insufficient evidence at present.
As with other forms of pulmonary edema, the hallmark of SIPE is a cough which may lead to frothy or blood-tinged sputum. Symptoms include:
It has been described in scuba divers, long-distance swimmers, and breath-hold divers.
Immersion causes increased external hydrostatic pressure, leading to redistribution of blood from the periphery to the chest, which increases cardiac filling pressures and stroke volume, and also reduces total lung capacity. There is a movement of fluid from the alveolar capillaries into the alveoli and extravascular lung tissues, which increases with time, and is normal in healthy humans when immersed. This is normally counteracted by the release of BNP which causes sodium and water excretion through the kidneys. This natriuresis is slow, so lung water increase is to some extent normal, but in susceptible people a higher rate of accumulation produces symptoms of SIPE
The alveoli of the lungs fill with edema fluid, causing dyspnoea, cough and frothy or bloodstained sputum. Gas exchange is affected, and as hypoxia increases there may be a loss of consciousness. Oxygenation in divers may be affected by breathing gas mix and partial pressure reduction due to ascent. In severe cases hypoxia may cause cardiac arrest and death. Research continues into the various factors causing IPO.
Possible aggravating factors include:
SIPE is believed to arise from some combinations of these factors, which overwhelms the ability of the body to compensate, and leads to alveolar flooding.