View source for Immersion pulmonary edema

==Background==
*Also known as Swimming-Induced Pulmonary Edema (SIPE)<ref>https://clinicaltrials.gov/ct2/show/NCT00815646 (Accessed 08/17/15)</ref>
*Populations affected: Combat swimmers (e.g. Navy SEALs), triathletes, and submersion divers (aka "breath-hold diving")<ref name="Miller">Miller CC 3rd, Calder-Becker K, Modave F. Swimming-induced pulmonary edema in triathletes. Am J Emerg Med. 2010 Oct;28(8):941-6.</ref>
**Prevalence approximately 1.8% in combat swimmers
**Very rare outside these groups
**Similar to exertion-related pulmonary edema (best described in racehorses)
*No good evidence-based risk factors identified, but hypertension appears to be associated<ref name="Miller" />
**There may also be some relation to overhydration.<ref name="Yoder">Yoder JA, Viera AJ. Management of swimming-induced pulmonary edema. Am Fam Physician. 2004 Mar 1;69(5):1046, 1048-9.</ref>
*Immersion increases cardiac output and doubles pulmonary artery pressures compared to being out of water<ref name="Miller" />
**Blood is also redistributed from extremities to the thorax. This effect is greater in cold water.<ref name="Ludwig" />

==Clinical Features<ref name="Ludwig">Ludwig BB, Mahon RT, Schwartzman EL. Cardiopulmonary function after recovery from swimming-induced pulmonary edema. Clin J Sport Med. 2006 Jul;16(4):348-51.</ref>==
*[[Cough]], [[dyspnea]] and/or [[hemoptysis]] immediately after water immersion
*No history of water aspiration or laryngospasm
*[[Hypoxia]] (SpO2 <92% or A-a gradient >30)
*[[CXR]] opacities consistent with interstitial pulmonary edema or alveolar filling process

==Differential Diagnosis==
{{Water related injuries DDX}}

==Evaluation==
[[File:MPX2168 synpic60403.png|thumb|Increased bronchial wall visibility (thickening), central peri-hilar haziness, slight alveolar filling, and Kerley B lines (red arrows) consistent with mild pulmonary edema. In this patient, swimming-induced pulmonary edema (SIPE). Also labeled: carina (white arrow) liver and spleen opacity in upper abdomen.]]
[[File:MPX2168 synpic50003.png|thumb|Central haziness with slight alveolar filling and Kerley B lines consistent with swimming-induced pulmonary edema (SIPE)]]
[[File:MPX2168 synpic50023.png|thumb|SIPE patient with greater patchy airspace opacities along and increased interstial markings.]]
*Clinical diagnosis, based on history and physical examination
*[[CXR]]
**opacities consistent with interstitial pulmonary edema or alveolar filling process
*CBC, BMP
*May consider [[ABG]]

==Management==
*Primarily supportive care, including supplemental oxygen<ref name="Yoder" /><ref name="Lund">Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med. 2003 Feb;41(2):251-6.</ref>
**Remove from water
**Remove cold clothes and place into a warm environment
**[[Albuterol]] may be used for symptomatic relief
*Typically resolves completely within 24-48 hours
*[[Sildenafil]] may prevent progression of pulmonary edema<ref>Moon RE et al. Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. Circulation. 2016; CIRCULATIONAHA.115.019464.</ref>
**Dosing uncertain, consider that the half-life is 4 hours

==Disposition==
*Discharge if asymptomatic or minimal symptoms, normal SpO2
*Otherwise, admit for observation

==See Also==
*[[Water-related injuries]]
*[[Submersion injury]]

==References==
<References/>

[[Category:Environmental]]