IPO/IPE considerations

[dmaziuk]

Article on my website about an incident I was involved in. At the bottom of that page there are links to some scientific papers on IPE.

Michael McFadyen's Scuba Diving Web Site

Your first link is "don't be a post-menopausal female" and the 2nd one, now that Rubicon let their domain registration lapse , goes to a probably-pr0n-but-I-can't-read-the-front-page-and-am-not-looking-further site.

 

[Kendall Raine]

A lot has been learned about IPE. If your friend's nephew was young and healthy, unfortunately it's likely that he had a predisposition to it. There is a subset of the population in whom the pulmonary arteries do not dilate sufficiently in response to the influx of blood from immersion-related fluid shifts. This produces pulmonary hypertension which can lead to pulmonary edema. Cold water and increased work while in the water can exacerbate this.

In @dmaziuk 's couch potatoes, there is probably a cardiac component as well.

Best regards,
DDM

Thank you, DDM

Is the type of predisposition you cite something one can be tested for? The type of thing that can develop with age (latency)? Is there a correlation between diving experience and IPE? That is, if it were going to happen, would it happen relatively early in one's diving career provided certain conditions were present (e.g. exertion, cold)?

 

[clownfishsydney]

Your first link is "don't be a post-menopausal female" and the 2nd one, now that Rubicon let their domain registration lapse , goes to a probably-pr0n-but-I-can't-read-the-front-page-and-am-not-looking-further site.

First link does work, it is a file on my website. I do not get anything like your statement.

I have fixed the second one to another copy of the paper. Thanks for letting me know.

 

[Duke Dive Medicine]

Thank you, DDM

Is the type of predisposition you cite something one can be tested for? The type of thing that can develop with age (latency)? Is there a correlation between diving experience and IPE? That is, if it were going to happen, would it happen relatively early in one's diving career provided certain conditions were present (e.g. exertion, cold)?

@Kendall Raine It's typically diagnosed, such as it is, after someone has a non-fatal episode. Re diving experience, it was first described in young, highly fit combat swimmers and has since been recognized in triathletes of a variety of ages. The mechanism is still not 100% clear but it's thought to be related to a combination of a predisposition, extremely high cardiac output while exercising, and possibly the unique cardiac muscle remodeling that happens with vigorous athletic training both in and out of the water, all of which interact to produce pulmonary hypertension. Cold water increases the likelihood because of the shunting of blood from the extremities to the core. There are other causes of pulmonary hypertension, so it can be difficult to tease out the root cause of individual episodes.

Best regards,
DDM

 

[Johnoly]

.. and has since been recognized in triathletes of a variety of ages.

Add high altitude(15k ft+) climbers to the list. What was sometimes called altitude sickness from shortness of breath,,, is now with stethoscopes and finding fluid in the lungs, being called IPE. Lots of unknowns about the triggers, but people are documenting it which is great for everyone!!

 

[Duke Dive Medicine]

Add high altitude(15k ft+) climbers to the list. What was sometimes called altitude sickness from shortness of breath,,, is now with stethoscopes and finding fluid in the lungs, being called IPE. Lots of unknowns about the triggers, but people are documenting it which is great for everyone!!

That would be considered high-altitude pulmonary edema (HAPE). Different mechanism.

Best regards,
DDM

 

[dmaziuk]

First link does work, it is a file on my website. I do not get anything like your statement.

First link: case history 1: 51yo female. Case history 2: 45yo woman. Case history 3: a 51yo experienced female diver.

 

[clownfishsydney]

First link: case history 1: 51yo female. Case history 2: 45yo woman. Case history 3: a 51yo experienced female diver.

Unsure what you mean. Case 1 is the one that was my friend and the dive I was on.

 

[dmaziuk]

Unsure what you mean. Case 1 is the one that was my friend and the dive I was on.

Not sure where I first saw it, but apparently women are several times more likely than men to get it. See e.g. this one: Risk factors for immersion pulmonary edema in recreational scuba divers: a case-control study - PubMed -- "divers over 50 years of age or with hypertension, especially women"

PS here's a review one: A literature review of immersion pulmonary edema - PubMed -- "The incidence of IPE is estimated to be around 1.1- 1.8%. The risk factors for IPE include age >50 years, female sex, ..."

 

[clownfishsydney]

Not sure where I first saw it, but apparently women are several times more likely than men to get it. See e.g. this one: Risk factors for immersion pulmonary edema in recreational scuba divers: a case-control study - PubMed -- "divers over 50 years of age or with hypertension, especially women"

PS here's a review one: A literature review of immersion pulmonary edema - PubMed -- "The incidence of IPE is estimated to be around 1.1- 1.8%. The risk factors for IPE include age >50 years, female sex, ..."

Yes, women more likely. Older people too.