The Immersion-Induced Pulmonary Edema in Swimming and Diving

Staying in or underwater can lead to acute pulmonary complaints, which clinically present as an acute immersion-induced pulmonary edema (IPE), particular in strenuous swimming (SIPE) or diving (DIPE). The IPE presents as a cardiac pulmonary edema and is induced by several pathophysiological processes during immersion, including fluid-shift, severe breathing, strenuous exercise, ambient cold, and aggravating cardiac pathologies. This clinical review summarizes current evidence about the incidence of IPE in general, SIPE, and DIPE, the main aspects of its complex underlying pathophysiology, clinical symptoms, outcome and prognosis. It furthers provides recommendations for emergency treatment and indication of hospital admission.