non-cardiogenic pulmonary edema

[Jax]

[-]Reefsong[/-] Gzimmermanmd, please see Denise' long story here: http://www.scubaboard.com/forums/ac...eniseggs-incident-near-miss-jackson-blue.html

A lot of people were looking up things and posting links. You may find valuable information, but the bottom line is that no one knows why this occurs.

 

[DocVikingo]

Hi Jax,

Reefsong's last post in this thread is dated October 23, 2004. Reefsong last signed onto the board on November 14, 2008. As such, you might wish to consider sending her a PM.

Some advances have been made in understanding the etiology of IME and the DAN link in Denise's post is old, quite brief and written for a lay audience. A more satisfying treatment of the topic can be found at J Appl Physiol. 2011 Mar;110(3):589-90. Epub 2011 Jan 13. Exploring the depths of immersion pulmonary edema.
Mahon RT. Undersea Medicine Dept., Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910-7500. Richard.Mahon@med.navy.mil.

Regards,

DocVikingo

 

[Jax]

Right - should have been addressed to Gzimmermanmd . . .

 

[Duke Dive Medicine]

[-]Reefsong[/-] ...the bottom line is that no one knows why this occurs.

Jax,
That's not 100% true. It's been demonstrated in our lab that immersion of the body in cold water, along with exercise, elevates pulmonary artery pressure; and that some people have very dramatic increases. We have a study under way right now looking at people who've actually had immersion pulmonary edema (aka swimming induced pulmonary edema). We're putting pulmonary artery catheters in them, immersing them in cold water, having them exercise, and then giving them sildenafil (viagra) to see if it lowers the PA pressure. We've only had a couple of subjects so it's not ready for publication, but so far the results have been pretty consistent. There are certainly people who are more susceptible to it than others... our last test subject is a triathlete who's had it four times.

Gzimmermanmd is talking about negative pressure pulmonary edema, which is a different animal than IPE. I've heard anecdotal reports like his about NPPE in divers but there's no literature on it that I'm aware of. @Gzimmermanmd: with your medical credentials, this might make a publishable case report. If we can assist in any way, please let me know.
Cheers,
DDM

 

[TSandM]

Interesting results, DDM. If they remain consistent, it would seem to me that people who have had IPE ought to be warned against further diving.

 

[Jax]

Jax,
That's not 100% true. It's been demonstrated in our lab that immersion of the body in cold water, along with exercise, elevates pulmonary artery pressure; and that some people have very dramatic increases. We have a study under way right now looking at people who've actually had immersion pulmonary edema (aka swimming induced pulmonary edema). <snipped>
Cheers,
DDM

Perhaps a better way I could have stated was, no one know why one person would get it over another . . . ?

 

[Duke Dive Medicine]

Interesting results, DDM. If they remain consistent, it would seem to me that people who have had IPE ought to be warned against further diving.

That's the way we're leaning. It's not consistent even in people who are susceptible, so we can't even recommend conditions under which they're ok to dive.

Perhaps a better way I could have stated was, no one know why one person would get it over another . . . ?

That's what Dr. Moon is trying to get to the bottom of right now. There appears to be a genetic link but there's nothing concrete yet.

 

[Midget]

Jax,
That's not 100% true. It's been demonstrated in our lab that immersion of the body in cold water, along with exercise, elevates pulmonary artery pressure; and that some people have very dramatic increases. We have a study under way right now looking at people who've actually had immersion pulmonary edema (aka swimming induced pulmonary edema). We're putting pulmonary artery catheters in them, immersing them in cold water, having them exercise, and then giving them sildenafil (viagra) to see if it lowers the PA pressure. We've only had a couple of subjects so it's not ready for publication, but so far the results have been pretty consistent. There are certainly people who are more susceptible to it than others... our last test subject is a triathlete who's had it four times.

DDM

EEP!! Maybe we need to make NO enriched scuba air!

Even though it is rare, this makes me want to throw a cpap mask and furosemide in my scuba first aid kit.

 

[TSandM]

The problem is that (non iatrogenic) pulmonary edema is almost never a condition of total body volume overload -- in fact, a lot of patients with pulmonary edema are volume contracted, but the volume they do have is in the wrong place. My guess is that anyone completing a dive is volume neutral or depleted (depending on whether they are diving a wetsuit or have a p-valve ). You'd be better off stocking your kit with nitro tablets!

 

[Cave Diver]

You'd be better off stocking your kit with nitro tablets!

Can you elaborate on this statement?