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Immersion pulmonary edema

Alfred A Bove
Although the lungs are a critical component of exercise performance, their response to exercise and other environmental stresses is often overlooked when evaluating pulmonary performance during high workloads. Exercise can produce capillary leakage, particularly when left atrial pressure increases related to left ventricular (LV) systolic or diastolic failure. Diastolic LV dysfunction that results in elevated left atrial pressure during exercise is particularly likely to result in pulmonary edema and capillary hemorrhage...
April 2016: Methodist DeBakey Cardiovascular Journal
Pierre Louge, Mathieu Coulange, Frederic Beneton, Emmanuel Gempp, Olivier Le Pennetier, Maxime Algoud, Lorene Dubourg, Pierre Naibo, Marion Marlinge, Pierre Michelet, Donato Vairo, Nathalie Kipson, François Kerbaul, Yves Jammes, Ian M Jones, Jean-Guillaume Steinberg, Jean Ruf, Régis Guieu, Alain Boussuges, Emmanuel Fenouillet
Immersion pulmonary edema (IPE) is a misdiagnosed environmental illness caused by water immersion, cold, and exertion. IPE occurs typically during SCUBA diving, snorkeling, and swimming. IPE is sometimes associated with myocardial injury and/or loss of consciousness in water, which may be fatal. IPE is thought to involve hemodynamic and cardiovascular disturbances, but its pathophysiology remains largely unclear, which makes IPE prevention difficult. This observational study aimed to document IPE pathogenesis and improve diagnostic reliability, including distinguishing in some conditions IPE from decompression sickness (DCS), another diving-related disorder...
June 2016: Medicine (Baltimore)
David R Pendergast, Richard E Moon, John J Krasney, Heather E Held, Paola Zamparo
Water covers over 70% of the earth, has varying depths and temperatures and contains much of the earth's resources. Head-out water immersion (HOWI) or submersion at various depths (diving) in water of thermoneutral (TN) temperature elicits profound cardiorespiratory, endocrine, and renal responses. The translocation of blood into the thorax and elevation of plasma volume by autotransfusion of fluid from cells to the vascular compartment lead to increased cardiac stroke volume and output and there is a hyperperfusion of some tissues...
October 2015: Comprehensive Physiology
Alfred A Bove
The cardiac effects of aquatic sports have increased in interest with the experience of cardiac responses to swimming and diving. The syndrome of swimming-induced pulmonary edema is likely caused by a combination of central blood shifts, sudden onset of high exercise demands, and impaired diastolic relaxation of the left ventricle. Divers also develop venous gas emboli caused by nitrogen supersaturation in blood and tissues during ascent from depth. The physiology and physics of water immersion and diving are unique...
July 2015: Clinics in Sports Medicine
Jiao Mu, Ji Zhang, Hongmei Dong, Liang Liu
Drowning is a leading cause of accidental death worldwide and its diagnosis is an important part of forensic investigation. It is generally acknowledged that hypoxia due to airway obstruction by fluid is the primary mechanism of death in drowning. Drowned individuals are usually found dead in the water or show severe clinical signs once out of the water. However, sudden death due to drowning after a short period of recovery following immersion/submersion has rarely been reported. A case of a 40-year-old man who died suddenly due to severe pulmonary edema about 40 min after he was recovered from an episode of immersion is reported...
March 2015: Forensic Science, Medicine, and Pathology
Dionne F Peacher, Stefanie D Martina, Claire E Otteni, Tracy E Wester, Jennifer F Potter, Richard Edward Moon
PURPOSE: Immersion pulmonary edema (IPE) occurs in swimmers (especially triathletes) and scuba divers. Its pathophysiology and risk factors are incompletely understood. This study was designed to establish the prevalence of preexisting comorbidities in individuals who experience IPE. METHODS: From 2008 to May 2010, individuals who had experienced IPE were identified via recruitment for a physiological study. Past medical history and subject characteristics were compared with those available in the current body of literature...
June 2015: Medicine and Science in Sports and Exercise
David R Smart, Martin Sage, F Michael Davis
Immersion pulmonary oedema (IPE) is being increasingly recognized in swimmers, snorkellers and scuba divers presenting with acute symptoms of respiratory distress following immersion, but fatal case reports are uncommon. We report two fatal cases of probable IPE in middle-aged women, one whilst snorkelling and the other associated with a scuba dive. In the snorkeller's case, an episode of exercise-related chest tightness and shortness of breath that occurred 10 months previously was investigated but this proved negative, and she was on no medications...
June 2014: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Andrew R Bamber, Jeremy W Pryce, Michael T Ashworth, Neil J Sebire
PURPOSE: To investigate the demographics, circumstances and autopsy findings in infants and children dying following immersion. METHODS: A retrospective review of a pediatric autopsy database at a specialist center over a 16-year period (1995-2010) was undertaken to identify deaths between 7 days and 16 years of age in whom death occurred following immersion. RESULTS: 28 infants and children died following immersion during the study period...
September 2014: Forensic Science, Medicine, and Pathology
Eric A Carter, John R Mayo, Martin J MacInnis, Donald C McKenzie, Michael S Koehle
BACKGROUND: High-altitude pulmonary edema (HAPE) and immersion pulmonary edema (IPE) are potentially life-threatening conditions that affect athletes, including high-altitude climbers, long-distance swimmers, and underwater divers. The objectives of this study were to measure lung density (before and after exercise) and quantify the pulmonary lymphatic network in individuals susceptible and resistant to HAPE/IPE. METHODS: Eighteen male (N = 10) and female (N = 8) subjects were recruited...
January 2014: Aviation, Space, and Environmental Medicine
G Cochard, A Henckes, S Deslandes, E Noël-Savina, M Bedossa, G Gladu, Y Ozier
It is well known that immersion pulmonary edema can be life-threatening for divers using a self-contained underwater breathing apparatus (scuba). Swimming-induced pulmonary edema in otherwise healthy individuals is not an object of dispute but its real severity is not well known and is probably underestimated. We report two cases of life-threatening acute respiratory distress while swimming and snorkeling, one of which is well documented for swimming-induced pulmonary edema. The interest of these case reports lies in the suddenness of these life-threatening events...
September 2013: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
B Weil, E Chaillou, F Troussier, C Pelatan, M Chiffoleau, E Darviot, M-C Chevalier, L Martin, J-L Giniès
INTRODUCTION: Aquagenic palmoplantar keratoderma (APK) is a cutaneous phenomenon marked by the formation of edematous, translucent papules and plaques on the palms after water immersion. It can be observed in healthy subjects, but while this dermatosis is little known by practitioners treating these patients, most cases of APK have been described in patients with cystic fibrosis (CF). The primary objective of this study was to evaluate the frequency of APK in a population of children with CF...
December 2013: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Pawel J Winklewski, Jacek Kot, Andrzej F Frydrychowski, Magdalena K Nuckowska, Yurii Tkachenko
Recreational scuba diving is a popular leisure activity with the number of divers reaching several millions worldwide. Scuba diving represents a huge challenge for integrative physiology. In mammalian evolution, physiological reflexes developed to deal with lack of oxygen, rather than with an excess, which makes adaptations to scuba diving more difficult to describe and understand than those associated with breath-hold diving. The underwater environment significantly limits the use of equipment to register the organism's functions, so, in most instances, scientific theories are built on experiments that model real diving to some extent, like hyperbaric exposures, dive reflexes or water immersion...
September 2013: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Monique E De Paepe, Svetlana Shapiro, Katrine Hansen, Füsun Gündoğan
Assessment of lung growth is a critical component of the perinatal autopsy. Increased lung liquid content may lead to overestimation of lung growth based on (wet) lung weight. In contrast, lung volume is not influenced by intraalveolar lung liquid. Our aim was to establish age-specific reference values for postmortem lung volume/BW in preterm and term infants. We performed a retrospective analysis of fetuses/infants (16-41 weeks' gestation) without (N = 134) or with (N = 79) risk factors for pulmonary hypoplasia...
January 2014: Pediatric Pulmonology
Emmanuel Gempp, Pierre Louge, Anne Henckes, Sebastien Demaistre, Phillipe Heno, Jean-Eric Blatteau
Immersion pulmonary edema in scuba divers is a rare disorder that tends to recur and can be potentially fatal, even in the absence of underlying cardiac disease. Anecdotal cases of reversible myocardial dysfunction have been described in this setting, but little is known of its pathogenesis. The purpose of the present study was to determine the clinical outcomes and the determinants associated with this condition. The data from 54 consecutive divers admitted for acute immersion pulmonary edema during a 5.5-year period were retrospectively studied...
June 1, 2013: American Journal of Cardiology
Jonathan Beynon
The article will give a brief introduction to what we understand by the term Asphyxiation. The main focus will then turn to how Asphyxiation is used as a method of torture, (often euphemistically called a "method of interrogation") with an overview of wet methods such as immersion in water or the pouring of water over the mouth and nose, and dry methods such as the use of bags/sacks/masks and how exacerbating factors such as the use of contaminants or irritants are used. The recently published International Forensic Expert Group Statement on Hooding will be introduced and the notion will be explored that during socalled 'enhanced interrogation' asphyxiation or drowning can be "simulated...
2012: Torture: Quarterly Journal on Rehabilitation of Torture Victims and Prevention of Torture
Meng Rui, Yun-You Duan, Xin-Hong Zhang, Hai-Long Wang, Da-Peng Wang
BACKGROUND: Few data are available on the role of neutrophil elastase (NE) and nuclear factor-κB (NF-κB) in the course of seawater drowning-induced acute lung injury (SWD-ALI), and there is no evidence on the value of giving urinary trypsin inhibitor (UTI) in the case of SWD-ALI. OBJECTIVE: To investigate the role of NF-κB and NE in the pathogenesis of SWD-ALI and whether UTI treatment can attenuate SWD-ALI in rabbits. METHODS: Rabbits were randomly assigned to control, seawater drowning, and UTI treatment groups...
2012: Respiration; International Review of Thoracic Diseases
A Henckes, J Arvieux, G Cochard, P Jézéquel, C C Arvieux
We report the case of a healthy 21-year-old woman who performed iterative breath-hold dives in relatively cold water, not exceeding depths of 5 meters but with "empty lungs." At the end of a dive, after experiencing an intense involuntary diaphragmatic contraction underwater, she presented hemoptysis followed by chest pain and cough. Chest radiography and computed tomography were performed 24 hours later, confirming the diagnosis of pneumomediastinum. The clinical course was benign: However, chest pain and effort dyspnea lasted for a few weeks...
May 2011: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
Melissa L Bates, Emily T Farrell, Marlowe W Eldridge
The question of whether pulmonary edema develops during exercise on land is controversial. Yet, the development of pulmonary edema during swimming and diving is well established. This paper addresses the current controversies that exist in the field of exercise-induced pulmonary edema on land and with water immersion. It also discusses the mechanisms by which pulmonary edema can develop during land exercise, swimming, and diving and the current gaps in knowledge that exist. Finally, this paper discusses how these fields can continue to advance and the areas where clinical knowledge is lacking...
2011: Pulmonary Medicine
Eric A Carter, Michael S Koehle
Pulmonary edema has been reported in SCUBA divers, apnea divers, and long-distance swimmers however, no instances of pulmonary edema in triathletes exist in the scientific literature. Pulmonary edema may cause seizures and loss of consciousness which in a water environment may become life threatening. This paper describes pulmonary edema in three female triathletes. Signs and symptoms including cough, fatigue, dyspnea, haemoptysis, and rales may occur within minutes of immersion. Contributing factors include hemodynamic changes due to water immersion, cold exposure, and exertion which elevate cardiac output, causing pulmonary capillary stress failure, resulting in extravasation of fluid into the airspace of the lung...
2011: Pulmonary Medicine
Emmanuel Gempp, Pierre Louge, Jean-Eric Blatteau, Michel Hugon
INTRODUCTION: Rebreathers are routinely used by military divers, which lead to specific diving injuries. At present, there are no published epidemiologic data in this field of study. METHODS: Diving disorders with rebreathers used in the French army were retrospectively analyzed since 1979 using military and medical reports. RESULTS: One hundred and fifty-three accidents have been reported, with an estimated incidence rate of 1 event per 3,500 to 4,000 dives...
April 2011: Military Medicine
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