0
Communications to the Editor |

Immersion Pulmonary Edema in Special Forces Combat Swimmers FREE TO VIEW

Richard T. Mahon, MD; Stewart Kerr, MD; Dennis Amundson, DO, FCCP; J. Scott Parrish, MD, FCCP
Author and Funding Information

Division of Pulmonary Medicine, Naval Medical Center, San Diego, CA

Correspondence to: Richard T. Mahon, MD, C/O Clinical Investigation Department, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134; e-mail: rtmahon@nmcsd.med.navy.mil



Chest. 2002;122(1):383-384. doi:10.1378/chest.122.1.383-a
Text Size: A A A
Published online

To the Editor:

We thoroughly enjoyed the review of pulmonary edema associated with scuba diving by Slade et al, in the November issue of CHEST.1As they mentioned, capillary stress failure appears to be central to the pathophysiology of this disorder as well as of other disorders, like high-altitude pulmonary edema. This topic is of great interest to us at the Naval Medical Center San Diego, where > 20 cases per year of pulmonary edema associated with surface swimming are evaluated. Generally, this condition occurs in special forces combat swimmers during intense training. Recently, three combat swimmers between the ages of 22 years and 28 years, without previous medical problems, simultaneously presented with unilateral radiographic findings of pulmonary edema. These patients were participating in a two-mile surface swim in 17°C ocean water. All were wearing 5-mm-thick neoprene wet suits that fit comfortably, all denied aspiration, and all complained of severe dyspnea and a nonproductive cough. Varying degrees of hypoxemia, tachypnea, and unilateral crackles (two right-sided and one left-sided) were observed. Radiographic findings included unilateral Kerley-B lines, cephalization, airspace consolidation, and normal cardiac size. Treatment consisted of supplemental oxygen and inhaled β-agonists. In each patient, hypoxemia resolved within 12 h, and results of chest radiographs normalized in 24 to 48 h. Navy combat swimmers swim primarily in a lateral decubitus position to allow constant eye contact with a partner and to maintain a low surface profile in the water. The dependent submersed lung was the radiographically affected lung in each of our three patients. We believe that increased central vascular volume associated with immersion,23 along with elevation of pulmonary vascular resistance4and regional differences in perfusion secondary to the forces of gravity and high cardiac output,56 exposed regional capillaries to relatively high pressures. We believe that unilateral pulmonary edema, as observed in these combat swimmers, reflected global and regional pulmonary vascular changes that led to stress failure of the capillary bed.

Slade, JB, Hattori, T, Ray, CS, et al (2001) Pulmonary edema associated with scuba diving: case reports and review.Chest120,1686-1694. [CrossRef]
 
Arborelius, M, Balldin, UI, Lilja, B, et al Hemodynamic changes in man during immersion with head above water.Aerosp Med1972;43,592-598
 
Lollgren, H, Nieding, G, Horres, R Respiratory and hemodynamic adjustment during head-out water immersion.Int J Sports Med1980;1,25-29. [CrossRef]
 
Keating, WR, Mcillroy, MB, Goldfein, A Cardiovascular response to ice-cold showers.J Appl Physiol1964;19,1145-1150
 
Hopkins, SR, McKenzie, DC, Schoene, RB, et al Pulmonary gas exchange during exercise in athletes: I. Ventilation-perfusion mismatch and diffusion limitation.J Appl Physiol1994;77,912-917
 
Younes, M, Bshouty, Z, Ali, J Longitudinal distribution of pulmonary vascular resistance with very high pulmonary blood flow.J Appl Physiol1987;62,344-358
 

Figures

Tables

References

Slade, JB, Hattori, T, Ray, CS, et al (2001) Pulmonary edema associated with scuba diving: case reports and review.Chest120,1686-1694. [CrossRef]
 
Arborelius, M, Balldin, UI, Lilja, B, et al Hemodynamic changes in man during immersion with head above water.Aerosp Med1972;43,592-598
 
Lollgren, H, Nieding, G, Horres, R Respiratory and hemodynamic adjustment during head-out water immersion.Int J Sports Med1980;1,25-29. [CrossRef]
 
Keating, WR, Mcillroy, MB, Goldfein, A Cardiovascular response to ice-cold showers.J Appl Physiol1964;19,1145-1150
 
Hopkins, SR, McKenzie, DC, Schoene, RB, et al Pulmonary gas exchange during exercise in athletes: I. Ventilation-perfusion mismatch and diffusion limitation.J Appl Physiol1994;77,912-917
 
Younes, M, Bshouty, Z, Ali, J Longitudinal distribution of pulmonary vascular resistance with very high pulmonary blood flow.J Appl Physiol1987;62,344-358
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543