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Swimming-induced pulmonary edema: evaluation of prehospital treatment with continuous positive airway pressure or positive expiratory pressure device
Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden; Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden.ORCID iD: 0000-0003-2026-2887
Örebro University, School of Medical Sciences. Sandviken North Primary Health Care Center, Sandviken, Sweden; Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden.
Örebro University, School of Medical Sciences. Department of Respiratory Medicine.ORCID iD: 0000-0003-1926-8464
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2022 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 162, no 2, p. 410-420Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Swimming-induced pulmonary edema (SIPE) occasionally occurs during swimming in cold open water. While optimal treatment for SIPE is unknown, non-invasive positive pressure ventilation (NPPV) is an option for prehospital treatment.

RESEARCH QUESTION: Is NPPV a feasible and safe prehospital treatment for SIPE, and which outcome measures reflect recovery after treatment?

STUDY DESIGN AND METHODS: A prospective observational study was conducted at Vansbrosimningen, Sweden's largest open water swimming event, in 2017-2019. Swimmers diagnosed with SIPE and with peripheral oxygen saturation (SpO2) ≤95% and/or persistent respiratory symptoms were eligible for the study. NPPV was administered on-site as continuous positive airway pressure (CPAP) by facial mask or as positive expiratory pressure device (PEP-device). Discharge criteria were SpO2 >95% and clinical recovery. Four outcome measures were evaluated: SpO2, crackles on pulmonary auscultation, pulmonary edema on lung ultrasound (LUS) and patient-reported respiratory symptoms.

RESULTS: Of 119 treated individuals, 94 received CPAP, 24 PEP-device and one required tracheal intubation. In total, 108 (91%) individuals were discharged after NPPV for median 10-20 minutes, 11 (9%) required hospital transfer. NPPV resulted in increased SpO2 from median 91% to 97% (p<0.0001) together with improvement of six patient-reported respiratory symptoms (median numerical rating scales 1-7 to 0-1; p<0.0001). No significant decrease in auscultation of crackles (93% vs 87%, p=0.508) or pulmonary edema on LUS (100% vs 97%, p=0.500) was seen during NPPV-treatment.

INTERPRETATION: NPPV administered as CPAP or PEP-device proved feasible and safe as prehospital treatment for SIPE with a vast majority of patients discharged on-site. SpO2 and patient-reported respiratory symptoms reflected recovery after treatment, whereas pulmonary auscultation or LUS did not.

Place, publisher, year, edition, pages
American College of Chest Physicians , 2022. Vol. 162, no 2, p. 410-420
Keywords [en]
CPAP, Continuous positive airway pressure, PEP-device, SIPE, lung ultrasound, positive expiratory pressure device, swimming-induced pulmonary edema, treatment, ultrasonography
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:oru:diva-98089DOI: 10.1016/j.chest.2022.02.054ISI: 000863173400023PubMedID: 35288117Scopus ID: 2-s2.0-85134311908OAI: oai:DiVA.org:oru-98089DiVA, id: diva2:1646024
Note

Funding agencies:

Center for Clinical Research Dalarna-Uppsala University (CKF)

Center for Research and Development

Uppsala University/Region Gävleborg(CFUG)

Ester Åsberg Lindbergs Foundation

Available from: 2022-03-21 Created: 2022-03-21 Last updated: 2024-03-06Bibliographically approved

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Seiler, ClaudiaKristiansson, LindaSundh, JosefinNilsson, Kristofer F.Hårdstedt, Maria

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