a Internal Medicine Residency Program , University of Connecticut , Farmington , CT , USA.
b Division of Cardiology , Hartford Hospital , Hartford , CT , USA.
Phys Sportsmed. 2019 May;47(2):148-151. doi: 10.1080/00913847.2018.1546104. Epub 2018 Nov 17.
Immersion pulmonary edema (IPE) is a rare but important complication associated with surface swimming and underwater diving. It tends to reoccur and can be fatal. It is not very well-known to clinicians involved in the care of individuals participating in aquatic activities. We performed a systematic review of immersion pulmonary edema to describe the condition and provide guidelines for its management.
We searched PubMed to identify case reports and studies using the MeSH terms "immersion," "pulmonary edema," "cold-induced," "exercise," "hemodynamics," "water immersion,'' "cardiovascular response," alone and in combinations. We identified 121 relevant articles including 54 case reports. We reviewed in detail 24 studies and all 54 case reports.
The incidence of IPE is estimated to be around 1.1- 1.8%. The risk factors for IPE include age >50 years, female sex, overhydration before exercise, tight wetsuits, cold water exposure and physically trained individuals such as endurance athletes. Individuals with pre-existing heart disease are at increased risk, however, IPE is seen even in healthy individuals. Symptoms such as cough, sputum production, hemoptysis and shortness of breath can occur immediately after immersion. Combination of water immersion, cold exposure, and exercise lead to an increase in pulmonary capillary pressures and eventual pulmonary capillary stress failure that leads to the flooding of alveolar spaces and edema. Conclusion and relevance: Clinicians should be aware of IPE to avoid overestimating the severity of coronary or valvular conditions sometimes coincidentally present in IPE victims. Management is usually supportive. Functional and clinical recovery usually happens spontaneously within 24 h to 2 days, with or without diuretic therapy and a beta-adrenergic agonist. IPE can be recurrent and fatal, hence subjects with a history of IPE should undergo extensive cardiopulmonary investigation and should avoid cold water and physically demanding swimming events or avoid immersion activities.
浸没性肺水肿(IPE)是一种与水面游泳和水下潜水相关的罕见但重要的并发症。它往往会再次发生,可能是致命的。参与水上活动的个体护理的临床医生对其了解甚少。我们对浸没性肺水肿进行了系统评价,以描述该病症并提供其管理指南。
我们在 PubMed 中搜索了使用 MeSH 术语“浸没”、“肺水肿”、“冷诱导”、“运动”、“血液动力学”、“水浸没”、“心血管反应”的病例报告和研究,单独和组合使用。我们确定了 121 篇相关文章,其中包括 54 篇病例报告。我们详细审查了 24 项研究和所有 54 篇病例报告。
IPE 的发病率估计约为 1.1-1.8%。IPE 的危险因素包括年龄>50 岁、女性、运动前过度水化、紧身潜水服、冷水暴露和体能训练的个体,如耐力运动员。有预先存在的心脏病的个体风险增加,但即使在健康个体中也会出现 IPE。咳嗽、咳痰、咯血和呼吸急促等症状可能在浸没后立即出现。水浸、冷暴露和运动的组合会导致肺毛细血管压力增加,最终导致肺毛细血管压力衰竭,导致肺泡空间充满和水肿。结论和相关性:临床医生应意识到 IPE,以避免高估有时同时存在于 IPE 受害者中的冠状动脉或瓣膜状况的严重程度。管理通常是支持性的。在没有或没有利尿剂治疗和β-肾上腺素能激动剂的情况下,功能和临床恢复通常会在 24 小时至 2 天内自发发生。IPE 可能会复发并致命,因此有 IPE 病史的患者应接受广泛的心肺调查,并应避免冷水和体力要求高的游泳活动或避免浸没活动。