Incidence and Impact of Swimming-Induced Pulmonary Edema on Navy SEAL Candidates

Volk, Charles; Spiro, Jeffrey D.; Boswell, Gilbert; Lindholm, Peter; Schwartz, Julia; Wilson, Zenus; Burger, Sara; Tripp, Michael S.

doi:10.1016/j.chest.2020.11.019

Cited by 20 publications

(20 citation statements)

References 22 publications

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“…Recently, an incidence of 5% was presented in a cohort of 2117 United States Navy Sea, Air, and Land Teams over 15 months based on radiologic findings. 19 One previous report from Unites States Experimental Diving Unit indicated a cumulative incidence of 1.78% among their trainees over 12 months; however, because of missing data, the definition of SIPE diagnosis was questionable. 20 In military training programs, the level of exertion often is extreme.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,14,17,18 Most studies are based on strenuous training programs during military training including young men. 5,6,14,19 In two of the first case series from military training, including 30 and 35 individuals, the incidence reported was surprisingly high: 27% and 60%, respectively. 5,6 Overhydrating before the race might have contributed to the high occurrence of SIPE in one of these studies.…”

Section: Respiratory Symptoms At the Mmumentioning

confidence: 99%

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Incidence of Swimming-Induced Pulmonary Edema

Hårdstedt

Kristiansson

Seiler

et al. 2021

Chest

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BACKGROUND: Despite increasing awareness of swimming-induced pulmonary edema (SIPE), large population-based studies are lacking and the incidence is unknown. RESEARCH QUESTION: What is the incidence of SIPE in a mixed group of competitive and recreational swimmers during a large open-water swimming event? METHODS: In four consecutive years (2016-2019), a prospective cohort study was conducted during Sweden's largest open-water swimming event, Vansbrosimningen. All swimmers seeking medical care with acute respiratory symptoms were eligible for the study. SIPE diagnosis was based on clinical findings in 2016 and 2017 and pulmonary edema assessed by lung ultrasound in 2018 and 2019. Data on patient characteristics, clinical findings, and information about the race were collected.RESULTS: Based on 47,573 consecutive swimming distances, 322 patients with acute respiratory symptoms (0.68%; CI, 0.61%-0.75%) were treated at the mobile medical unit. Of these, 211 patients (0.44%; CI, 0.39%-0.51%) received a diagnosis of SIPE. The annual incidence of SIPE was 0.34%, 0.47%, 0.41%, and 0.57%, respectively, from 2016 through 2019. Most patients diagnosed with SIPE were women (90%), despite about equal percentages of men and women participating (47% men and 53% women). The incidence of SIPE overall was 0.75% in women and 0.09% in men. The incidence increased with age, from 0.08% in the youngest age group (18-30 years) to 1.1% in the oldest age group ($ 61 years). Based on multiple logistic regression analysis, the adjusted odds for SIPE occurring was 8.59 times higher for women compared with men and 12.74 times higher for the oldest age group compared with the youngest age group. INTERPRETATION:The incidence of SIPE over 4 years during a large open-water swimming event in Sweden was 0.44%. The incidence was higher in women than in men and increased with age.

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Section: Discussionmentioning

confidence: 99%

Section: Respiratory Symptoms At the Mmumentioning

confidence: 99%

Incidence of Swimming-Induced Pulmonary Edema

Hårdstedt

Kristiansson

Seiler

et al. 2021

Chest

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“…15 Six of these patients were treated in hospital, two with CPAP and four with bilevel positive airway pressure. [12][13][14]16,17 Treatment duration with NPPV, reported in three of the hospitalized patients, ranged from 90 min to 6 h. 13,14,17 Only one patient receiving prehospital CPAP treatment, without reported treatment duration, was described by Cochard et al 9 In divers with immersion pulmonary edema, a condition similar to SIPE, NPPV has been recommended before pharmacologic treatment. 38,39 However, scientific evidence regarding treatment of immersion pulmonary edema in divers is lacking as well.…”

Section: Data Collection and Outcome Measuresmentioning

confidence: 99%

“…5,11 Interestingly, other than a pilot study published by our research group in 2016, we could find only seven cases of patients treated with NPPV for SIPE in the literature. 9,[12][13][14][15][16][17] An important aspect of prehospital care for SIPE is the growing popularity of open water swimming competitions that challenges the surrounding health care organizations. 15,18 Vansbrosimningen is the largest open water swimming event in Sweden and attracts approximately 11,000 participants yearly.…”

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confidence: 99%

Swimming-Induced Pulmonary Edema

Seiler

Kristiansson

Klingberg

et al. 2022

CHEST

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“…1 Although series of SIPE patients have been published before, this mostly concerned cohorts of very fit males, often military trainees or triathletes. 2,3 While the participants in the swimming race described in the current paper were undoubtedly above average in fitness, they formed a mixed population, including adults of all ages. SIPE is usually self-limiting, but fatal cases have been described.…”

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confidence: 95%