Can Scuba Diving Cause Pulmonary Edema?

Immersion pulmonary edema (IPE), also known as swimming-induced pulmonary edema (SIPE), is a rare, underrecognized, and potentially lethal pathology that can occur during water sports activities. It is often observed in young individuals with no predisposing conditions, such as scuba divers, snorkelers, triathletes, and military swimmers. The causes of IPE are incompletely understood as of 2010.

Physiological studies have revealed that factors that could contribute to pulmonary edema in scuba divers include scuba valve failure, low tank air pressure with certain types of regulators, a tank not turned completely on, and the use of a breathing apparatus. Swimming-induced pulmonary edema (SIPE) occasionally occurs during swimming in cold open water. Although optimal treatment for SIPE is unknown, non-invasive positive pressure ventilation (NPPV) is an potential complication.

IPE is often used as an umbrella term for scuba divers pulmonary edema (SDPE) and swimming-induced pulmonary edema (SIPE). Both conditions share similar presenting symptoms. Medical diagnosis is the process of determining which disease or condition explains a person’s symptoms and signs. As the number of divers of retirement age rises, dive safety researchers are increasingly interested in IPE.

Overhydrating before swimming or diving increases the risk of IPE. Excessive fluid intake can disrupt the lungs’ ability to breathe due to increased density of gas under pressure. Diving can cause more negative pressure in the lungs during breathing due to the increased density of gas under pressure and can be worsened by overhydration.

What is the most plausible cause of pulmonary edema?

Pulmonary edema is a condition in which too much fluid accumulates in the lungs, interfering with a person’s ability to breathe normally. The problem is usually related to heart disease, but it has other possible causes, including kidney failure, blood transfusion reactions, or travel to destinations at high elevation.

When the heart and lungs are functioning normally, the organs are able to manage fluid movement within the body, including the exchange of fluid between the heart and lungs. But sometimes, a problem within the chamber on the left side of the heart (the left ventricle) creates excess fluid pressure and causes blood to pool, which can overwhelm the lungs.

When fluid comes into the lungs too quickly for them to clear it effectively, the excess fluid is shunted into the lung’s tiny, delicate air sacs; these are meant to hold gas, not fluid, and are critical for breathing. This is why the sensation feels like drowning. Pulmonary edema is an emergency situation, because people with the condition are not receiving the oxygen they need.

What is most likely to cause pulmonary edema?

People who are at increased risk of pulmonary edema include those with:Irregular heartbeat (arrhythmia)High blood pressure (hypertension)Heart attack.Stroke.Pneumonia.Liver disease.Kidney disease or injury.Lung injury.

Pulmonary edema describes a condition in which fluid builds up in the lungs, making it difficult to breathe. Most often, the buildup of fluid is caused by a pressure imbalance within the heart, but other causes can also send excess fluid to the lungs. If the fluid is arriving at a faster rate than the lungs can clear it, parts will fill, making it difficult—if not impossible—for the lungs to take in oxygen and deliver it to the rest of the body, as they are meant to do.

People who experience pulmonary edema may struggle to breathe; the feeling has been described as being like drowning or suffocating. Some people cough up a thick, pink, frothy liquid while struggling for air.

Pulmonary edema can be a life-threatening condition. Immediate medical attention is essential. Extra oxygen can be given to help patients breathe more effectively, while other treatments to remove fluid from the lungs and manage the heart-related pressure problems that caused the fluid buildup can also make a difference.

What is the most common complication of scuba diving?

Ear & Sinus. The most common injury in divers is ear barotrauma (Box4-07). On descent, failure to equalize pressure changes within the middle ear space creates a pressure gradient across the eardrum. As the middle ear tissues swell with edema—a consequence of the increased pressure—the pressure difference across the eardrum pushes it into the middle ear space, causing it to bleed and possibly rupture.

Forceful equalization under these conditions can increase the pressure differential between the inner ear and the middle ear, resulting in round window rupture with perilymph leakage and inner ear damage. To avoid these pathologic processes, divers must learn proper equalization techniques. Health care providers can coach this effort byobserving movement of the tympanic membrane using simple otoscopy.

Paranasal sinuses, because of their relatively narrow connecting passageways, are especially susceptible to barotrauma, generally on descent. With small changes in pressure (depth), symptoms are usually mild and subacute but can be exacerbated by continued diving. Larger pressure changes can be more injurious, especially with forceful attempts at equilibration (e.g., the Valsalva maneuver). Additional risk factors for ear and sinus barotrauma include:

What is dyspnea after scuba diving?

Comment. This diver experienced classic symptoms of immersion pulmonary edema (IPE). IPE, also known as swimming-induced pulmonary edema (SIPE), is a condition that has been described in scuba divers, snorkelers, triathletes, and military swimmers. The condition is characterized by dyspnea (shortness of breath), hemoptysis (coughing up bloody sputum), and symptoms of respiratory distress. Extreme fatigue and a sensation of ‘wet’ lungs are also common. Symptoms are not depth-dependent, meaning IPE can occur with any immersion. It has been theorized that IPE results from increased pulmonary artery pressure in part triggered by immersion in susceptible individuals.

During immersion, blood is rerouted from the periphery to the core resulting in increased blood volume in the thorax and thus increased pressures in the pulmonary vasculature. Development of IPE may be from this effect in concert with a multitude of other contributing factors including cold water, hyper-hydration, uncontrolled hypertension, heavy exertion, and high breathing resistance (particularly on inhalation). As with this case, it is important to note that not all of these factors may be present for a case to develop. IPE has been reported in warm water and with immersed activity of varying exertion. Given the possible severity of the condition or the possibility of other serious conditions presenting with similar symptoms, it is recommended that medical attention is provided.

While research is assessing the contribution of different factors, there is currently no way to predict susceptibility to IPE. Mild symptoms of IPE may be initially discounted, delaying attention to the acuteness of the situation. As in this case, it is important for divers to be familiar with the condition so symptoms can be recognized and appropriate action taken. While a diver experiencing symptoms should leave or be assisted out of the water as quickly as possible, proper procedures must be followed to do so safely. For example, completing obligatory decompression helps to avoid other potentially serious problems. If symptoms occur at depth, the victim should communicate with their buddies, evaluate surface safety, and make a controlled ascent. Once in a safe place out of the water, exertion should be limited, oxygen provided, and medical evaluation arranged. The diver in the situation described above reacted appropriately to the dangerous situation. He relayed his symptoms to his dive buddies and requested assistance back to the shore so that he could be medically evaluated.

What is the number one cause of pulmonary edema?

Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.

Definition. Pulmonary edema is an abnormal buildup of fluid in the lungs. This buildup of fluid leads to shortness of breath.

Alternative Names. Lung congestion; Lung water; Pulmonary congestion; Heart failure – pulmonary edema.

Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs.

What are the symptoms of pulmonary barotrauma?

Pulmonary barotrauma – Hoarseness, neck fullness, and chest pain several hours after diving. Shortness of breath, painful swallowing, and loss of consciousness also may occur. Air embolism – Sudden loss of consciousness within 10 minutes of surfacing.

Barotrauma oftenrefers to medical problems that arise from the effects of water pressure when a scuba diver is beneath the surface. Water is heavier than air, so when you dive, small changes in depth cause large changes in pressure underwater.

• External ear squeeze occurs when your ear canal is blocked by something such as earplugs or earwax. As the water pressure increases while you descend, the air pocket between the obstruction and the tympanic membrane (eardrum) shrinks. This can damage the tissue in the ear canal, usually your eardrum.
• Middle ear squeeze occurs when you cannot equalize the pressure in your middle ear. This is the most common problem for divers. The eustachian tube is a small canal that connects the middle ear to the back part of the nasal cavities and allows pressure to equalize. When there is a problem with the tube, the middle ear volume decreases and pulls the eardrum inward, creating damage and pain. You can try certain maneuvers, called Valsalva maneuvers, such as yawning or trying to blow with your nose and mouth closed, to open the tube and equalize the pressure.
• Inner ear barotrauma occurs from the sudden development of pressure differences between the middle and inner ear. This can result from an overly forceful Valsalva maneuver. The result is usually ringing in the ear, dizziness, and deafness. This injury is less common than a middle ear squeeze.

Less common types of barotrauma involve air trapped in an enclosed area that cannot equalize during descent. This causes a vacuum effect that can result in:

Can you get pulmonary edema from inhaling water?

• Acute respiratory distress syndrome (ARDS). This serious disorder occurs when the lungs suddenly fill with fluid. Many conditions can cause acute respiratory distress syndrome (ARDS), including severe injury (trauma), widespread infection (sepsis), pneumonia and severe bleeding.
• Drug reaction or drug overdose. Many drugs — ranging from aspirin to illegal drugs such as heroin and cocaine — are known to cause pulmonary edema.
• Blood clot in the lungs (pulmonary embolism). A blood clot moving from the blood vessels in the legs to the lungs can cause pulmonary edema.
• Exposure to certain toxins. Inhaling toxins or breathing in some stomach contents when vomiting (aspiration) causes intense irritation of the small airways and air sacs, resulting in fluid buildup.
• High altitudes. Pulmonary edema has been seen in mountain climbers, skiers, hikers and other people who travel to high elevations, usually above 8,000 feet (about 2,400 meters). High-altitude pulmonary edema (HAPE) generally occurs in those who don’t take the days or weeks needed to become used to the elevation. But people who live at high altitudes can get HAPE with no elevation change if they have a respiratory illness.
• Near drowning. Inhaling water causes fluid buildup in the lungs.
• Negative pressure pulmonary edema. A blocked upper airway causes negative pressure in the lungs from trying to breathe through the blockage. With treatment, most people with this type of pulmonary edema recover in about 24 hours.
• Nervous system conditions or surgeries. A type of pulmonary edema called neurogenic pulmonary edema can occur after a head injury, seizure or brain surgery.
• Smoke inhalation. Smoke from a fire contains chemicals that damage the membrane between the air sacs and the capillaries. The damage allows fluid to enter the lungs.
• Transfusion-related lung injury. Blood transfusions may cause fluid overload in the left ventricle, leading to pulmonary edema.
• Viral illnesses. Viruses such as the hantavirus and dengue virus can cause pulmonary edema.

Air sacs in the lungs, called alveoli, take in oxygen and release carbon dioxide. In high-altitude pulmonary edema (HAPE), it’s believed that blood vessels in the lungs squeeze together (constrict), increasing pressure. This causes fluid to leak from the blood vessels to the lung tissues and eventually into the air sacs.

Heart failure and other heart conditions that raise pressure in the heart increase the risk of pulmonary edema. Risk factors for heart failure include:

What is wet lung from diving?

(Swimming-Induced Pulmonary Edema; SIPE) Immersion pulmonary edema is sudden development of fluid in the lungs that typically occurs early during a dive and at depth. (See also Overview of Diving Injuries.) Immersion pulmonary edema has become more widely recognized over the past two decades.

Who should not do scuba diving?

Do you have a history of ear or sinus surgery? Are you currently suffering from a cold, congestion, sinusitis or bronchitis? Do you have a history of respiratory problems, severe attacks of hayfever or allergies, or lung disease? Have you had a collapsed lung (pneumothorax) or history of chest surgery?

Are you ready to take the step and embark on the great adventure of scuba diving ?

Scuba diving is an exciting and demanding activity.

To scuba dive you must not be extremely overweight or out of condition.

Can you get pulmonary edema from diving?

Introduction. Immersion pulmonary edema, also known as swimming-induced pulmonary edema (SIPE), is a condition in which cough, dyspnea, hemoptysis, and hypoxemia develop after surface swimming or diving, often in young, healthy individuals.

Can breath-hold diving cause pulmonary edema?

The pathophysiology leading to the formation of pulmonary edema in breath-hold diving depends on an increase in intrathoracic blood volume and hence increased pulmonary capillary transmural pressure.