Diferencia entre revisiones de «Immersion pulmonary edema»

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*Also known as Swimming-Induced Pulmonary Edema (SIPE)<ref>https://clinicaltrials.gov/ct2/show/NCT00815646 (Accessed 08/17/15)</ref>
*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>
*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 approx 1.8% in combat swimmers
**Prevalence approximately 1.8% in combat swimmers
**Very rare outside these groups
**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" />
*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" />
*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==
==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==
==Differential Diagnosis==
{{Water related injuries DDX}}
{{Water related injuries DDX}}


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


==See Also==
==See Also==
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<References/>
<References/>


[[Category:Environ]]
[[Category:Environmental]]

Revisión actual - 12:58 29 may 2022

Background

  • Also known as Swimming-Induced Pulmonary Edema (SIPE)[1]
  • Populations affected: Combat swimmers (e.g. Navy SEALs), triathletes, and submersion divers (aka "breath-hold diving")[2]
    • 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[2]
    • There may also be some relation to overhydration.[3]
  • Immersion increases cardiac output and doubles pulmonary artery pressures compared to being out of water[2]
    • Blood is also redistributed from extremities to the thorax. This effect is greater in cold water.[4]

Clinical Features[4]

  • 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

Evaluation

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.
Central haziness with slight alveolar filling and Kerley B lines consistent with swimming-induced pulmonary edema (SIPE)
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[3][5]
    • 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[6]
    • 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

References

  1. ↑ https://clinicaltrials.gov/ct2/show/NCT00815646 (Accessed 08/17/15)
  2. ↑ 2.0 2.1 2.2 Miller CC 3rd, Calder-Becker K, Modave F. Swimming-induced pulmonary edema in triathletes. Am J Emerg Med. 2010 Oct;28(8):941-6.
  3. ↑ 3.0 3.1 Yoder JA, Viera AJ. Management of swimming-induced pulmonary edema. Am Fam Physician. 2004 Mar 1;69(5):1046, 1048-9.
  4. ↑ 4.0 4.1 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.
  5. ↑ Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med. 2003 Feb;41(2):251-6.
  6. ↑ Moon RE et al. Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. Circulation. 2016; CIRCULATIONAHA.115.019464.
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