Isolated pulmonary oedema associated with SCUBA diving

Abstract

Pulmonary oedema may be a presenting feature of the classical diving illnesses decompression illness and barotrauma, but it may also present as an isolated phenomenon. Possible causes include: salt water aspiration syndrome or near drowning (sometimes associated with faulty apparatus); and cold, immersion and exercise‐induced pulmonary oedema. The pathophysiology may involve peripheral vasoconstriction; changes in preload, afterload and circulating fluid volume; and pulmonary capillary fragility. A case that presented to Auckland Hospital is discussed, together with a review of the literature. In this case, treatment with continuous positive airway pressure ventilation proved highly effective. Guidelines for the use of continuous positive airway pressure ventilation in diving‐related accidents are presented.

Scuba diving, swimming and pulmonary oedema

“…Negative pressure pulmonary oedema developing during vigorous attempts to breathe against a faulty regulator was also considered unlikely as new equipment was used during the second dive and the original regulator had been thoroughly checked and no fault found 8,9 . Sotolol may have contributed to his symptoms by impairing the myocardial response to increased preload 10 …”

“…8,9 Sotolol may have contributed to his symptoms by impairing the myocardial response to increased preload. 10 In summary, acute pulmonary oedema during diving is a very uncommon problem, particularly in warm waters, and has been reported in association with AF only once before. 1 We have recommended that the patient should not return to professional diving, although previous reports suggest that a return to more conservative diving activities can occur without recurrence.…”

Swimming-Induced Pulmonary Edema

“…[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.…”