SIPE

Swimming Induced Pulmonary Edema

Occurrence, research

Occurs in divers and swimmers. Has been described in the literature in the last 20-30 years in connection with military diving, triathlon and outdoor swimming. Little specific research has been done on SIPE, but medical research on general pulmonary edema has come a long way. So far there are indications that SIPE occurs with a frequency of 1-2%.

The people who probably know most about this to date are the health and safety team at Vansbrosimningen. They envounter around 50 cases each year that are treated and observed. Some cases require intensive care in hospital. The majority of those affected are women.

Symptoms

  • Dyspnea (shortness of breath)
  • Cough, initially dry cough, later with frothy mucus that may be mixed with blood
  • Rattling, whirring sounds from the lungs during breathing
  • Cyanosis (blue discoloration, especially of lips)
  • Reduced energy level, feeling extra tired
  • Reduced oxygen saturation (can only be ascertained by authorized healthcare personnel)
  • Changes may occur in the ECG (can only be ascertained by authorized healthcare personnel)

Cause and underlying mechanisms

There are several factors that contribute to fluid being pushed out into the alveoli (i.e. pulmonary edema) in divers and outdoor swimmers:

  • Immersion in water. Increased hydrostatic pressure causes blood to be pushed from the arms and legs towards the central body parts
  • Cold water. Reduced body temperature means that blood circulation is concentrated centrally in the body to a greater extent
  • Effort. Heart, lungs, muscles need oxygen-rich blood
  • Inadequate ventilation of the lungs. Poor floating position with accompanying poor breathing technique, stress
  • Reduced oxygen saturation accelerates the process
  • A wetsuit that is too tight can possibly worsen the situation

Risk factors

  • Reduced lung function (infection, asthma, COPD)
  • Previous heart failure (or undiagnosed heart problems)
  • Hypertension (high blood pressure), pulmonary hypertension (too high pressure in the pulmonary circulation, more specifically in the pulmonary artery)
  • Former SIPE
  • Being a woman

How can one reduce the risk of SIPE?

  • Efficient warm-up
  • Warming up in water, swimming, getting used to the water temperature and reducing stress
  • Wetsuit that fits
  • Do not drink large amounts of liquid immediately before the start

How do we detect SIPE?

Health and safety personnel during the swimming competition should be informed about SIPE so that they can quickly detect if a swimmer exhibits typical symptoms such as difficulty breathing, coughing, or seems excessively tired. The information above will also be able to help the individual swimmer recognize the symptoms in themselves and inform health and safety personnel of any suspicions.

What to do if you suspect SIPE

If SIPE is suspected the swimmer must get out of the water and be assessed by a physician. The physician then considers whether the swimmer needs to be treated or not. Undiagnosed and untreated SIPE can develop into a life-threatening condition so medical supervision is required.

It is also important that SIPE cases are documented both to increase our own experience but also to be able to say something more precisely about how often SIPE occurs.

Follow-up and treatment

  • The swimmer must get out of the water
  • Sitting position
  • Remove wetsuit
  • Protect against cooling, heat
  • Calm and stress-free atmosphere
  • Transport to emergency room or hospital
  • If possible, administer oxygen along the way

Not for regular crew:

  • Physician (or other authorized personnel) checks vital parameters, oxygen saturation, breath sounds, ECG
  • Physician considers CPAP, Furix or other common pulmonary edema treatment
  • Emergency room/hospital determines further follow-up