CHEST Guidelines-Swimming-Induced-Pulmonary-Edema

Swimming-Induced-Pulmonary-Edema_chest

Pdf Summary

In this editorial published in the CHEST journal, Robert P. Weenink and Thijs T. Wingelaar discuss a study by Hårdstedt et al. that explores the incidence of swimming-induced pulmonary edema (SIPE) in a large cohort of open-water swimmers. The current literature typically focuses on very fit individuals, such as military trainees and triathletes, reporting varying incidence rates—1.4% in triathletes and up to 60% in strenuous swimming, with the new study marking an incidence of 0.44% among a mixed population of swimmers.<br /><br />SIPE often resolves on its own but can be fatal in rare cases. A significant finding in the study is the higher likelihood (Odds Ratio of 8.59) of SIPE occurring in women compared to men, potentially linked to cardiovascular physiological differences, such as diastolic stiffness of the left ventricle being higher in women. Additionally, a high incidence of bronchial asthma, particularly in women, was noted in the cohort. The role of bronchial asthma in SIPE development warrants further investigation, even though it appears asthma exacerbation is clinically distinct from SIPE.<br /><br />The editorial also discusses pathophysiological mechanisms contributing to SIPE, including factors like cold-induced peripheral vasoconstriction, immersion-induced central volume redistribution, and wetsuit compression. The remote nature of the swimming event suggests comprehensive data collection, as few would bypass local medical services to visit distant hospitals.<br /><br />Hårdstedt et al. previously proposed using lung ultrasound as a diagnostic tool for SIPE, which the current study further validates. Accurate SIPE diagnosis pre-hospital is crucial due to variable in-hospital findings. Despite challenges in pinpointing SIPE's true incidence, this study's contributions include identifying increased risk in women and exploring asthma's association, offering avenues for future research.

Keywords

swimming-induced pulmonary edema

SIPE

open-water swimmers

incidence rates

lung ultrasound

bronchial asthma

cardiovascular physiology

gender differences

pathophysiology

diagnostic tools