Updated case review on immersion pulmonary edema

[Duke Dive Medicine]

Thank You DDM.

I agree that it may be difficult to differentiate IPE from other respiratory symptoms. However, there are some important differences that may help the affected diver identify IPE, such as

· new and sudden onset of coughing.
· Expectorate having metallic/bloody taste
· Noticing new onset wheezing
· With the above, increased difficulty breathing etc.

Perhaps the other thing to stress is the importance of oxygen/breathing an enriched mix. There have been unverified reports of people dying at the surface with IPE and air (21%) in their tanks. Considering a lot of divers diving nitrox, perhaps one recommendation could be to continue breathing enriched air until 100% can be delivered on the boat. For those technical divers, we usually carry a richer mix and on CCR can drive the PO2 higher.

I understand if DDM and DAN may not be able to make those recommendations due to legal concerns.

Thank you for keeping us updated and Happy Veterans Day!

Claudia

Claudia,

Thank you! We appreciate everyone who served or is serving in the military.

IPE would be in the differential for the symptom set you mentioned but so would pulmonary DCS (depending on the symptom onset time), pulmonary embolus and cardiogenic pulmonary edema. Self-diagnosis could lead to a suboptimal outcome.

I agree completely with your recommendation for providing a hyperoxic diving mix to someone with respiratory distress if 100% O2 isn't available on the boat.

Best regards,
DDM

 

[raftingtigger]

Perhaps more of our medicos can chime in on this but....

The study cites 72 per cent of the group as having one of many comorbidities. But if we grab a random group of Americans in that age group, (49 years old plus or minus 9 years) isn't that a similar percentage as the group affected by IPE? Obesity is just one of the conditions they list. Doesn't that alone affect non IPE people in high percentages? If we add hypertension, asthma and a few others, couldn't we get over 70 per cent of the general population as easily as a population of people affected by IPE?

Maybe some of our scuba docs can tell us a little more about what the numbers in this study tell us.

A random group of Americans in that age group and a random group of divers in that age group could have vastly different levels of co-morbidities. I would expect the diving population (49 years +/- 9 years) would have significantly fewer co-morbities than the same age group of Americans.

To make sense of the prevalence of co-morbities in the IPE group you need to know the prevalence of co-morbidities in a control diving group. Not having access to the entire study I can't say that those numbers are included, but suspect they are.

 

[Jax]

Thank you for making this available. I can tell you however, I had a negative cardiac work-up after my incidence 2 years ago. I did not then and currently have no medical conditions. So there are a number of divers who for "no apparent" reason might experience IPE.
Some authorities recommend the cesation of diving activity after an event of IPE to prevent a possible recurrence. I will tell you that I have continued diving and went deeper and longer, gratefully without incidence. Can it happen again? Absolutely. BUT: what those who have not been aflicted must realize is that it could happen to anyone, including them. It happened to me, a very fit, healthy, normal weight, diver on a recreational dive (not one of my deep trimix cave dives) in warm water.

The only thing that I can think of that may have been a precipitating factor was 1. Overhydration prior to diving 2. A borrowed wetsuit that was a bit too tight.

I applaud Duke Medicine for researching this phenomena. One, that appears more common than previously appreciated. Thanks to the dedicated physicians and scientists, we gain the valuable insights needed to formulate a preventative course of action.

If possible and more practical for us divers would be now to get recommendations from Duke or DAN as to how to 1. recognize IPE, 2. what to do underwater with a buddy with potential IPE, 3. how to deal with IPE at the surface, etc.

Thank you Duke!

Claudia Roussos MD

I just found this link - thank you very much, Dr Roussos. Easy reading for a lay person.

Add Helium - The Rebreather Epicenter