Developmental features of immersion pulmonary edema in divers

Introduction. Immersion pulmonary edema (IPE) is a pathological condition that occurs in an aquatic environment during various activities, such as underwater engineering, scuba diving, triathlon competitions, etc. Despite a significant number of English-language publications, the problem of IPE remains insufficiently studied in Russia.

Objective. Research into the diagnosis, clinical manifestations, treatment, and prevention of IPE to optimize medical care for this pathological condition.

Discussion. The main factors leading to IPE include exposure to cold water, intense physical exertion during swimming, increased blood pressure while in water, excessive fluid intake before swimming, age over 50. Breathing 100% oxygen underwater can cause hyperoxia, oxidative stress, disruption of the alveolar–capillary membrane integrity, and surfactant deficiency, leading to fluid transudation into the pulmonary interstitial tissue and edema. Hyperoxia induces pulmonary vasoconstriction, increases hydrostatic pressure, and enhances fluid filtration into the interstitium, exacerbating IPE and contributing to the development of alveolar pulmonary edema. Clinically, IPE presents with labored breathing, acute dyspnea, coughing with hemoptysis, frothy bloody discharge, and other symptoms. A distinctive feature of this condition is the resolution of key symptoms within 48 h. On physical examination, percussion over the affected lung area reveals dullness, while auscultation detects wet rales in the lungs and murmurs characteristic of acute mitral regurgitation with left ventricular failure. Computed tomography findings include ground-glass opacities, peribronchial infiltration, and pleural effusion, predominantly on the affected side. A major limitation of this method is the inability to perform imaging immediately during an emergency ascent. Ultrasound diagnostic markers of IPE include hyperechoic reverberation artifacts (B-lines), produced by the interaction of ultrasound waves with air-fluid content in the alveoli, typical of pulmonary edema. Clinical and laboratory markers of IPE include elevated levels of copeptin, brain natriuretic peptide (BNP), ischemia-modified albumin, and high-sensitivity troponin T.

Conclusions. IPE remains an understudied yet highly dangerous pathological condition in diving and aquatic swimming. Therefore, it is crucial to educate divers, combat swimmers, professional scuba divers, and athletes (triathletes, swimmers) about preventive measures and symptom recognition when they occur during surface or underwater activities. Implementing a comprehensive approach to IPE prevention will reduce the incidence of this condition and enhance the safety of diving operations.

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