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Swimming-Induced Pulmonary Edema: Diagnostic Criteria Validated by Lung Ultrasound
Department of Cardiology, Falun Hospital, Falun, Sweden; Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden.ORCID iD: 0000-0002-3671-5046
Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden; Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden; Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden.ORCID iD: 0000-0003-2026-2887
Sandviken North Primary Health Care Center, Sandviken, Sweden; Center for Research and Development, Uppsala University, Region Gävleborg, Sweden.
Department of Internal Medicine, Mora Hospital, Mora, Sweden.
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2020 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 158, no 4, p. 1586-1595Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite the increasing popularity of open water swimming worldwide, swimming-induced pulmonary edema (SIPE) is a poorly recognized condition lacking established diagnostic criteria.

RESEARCH QUESTION: The aim of this study was to identify diagnostic criteria of SIPE during a large open water swimming event.

STUDY DESIGN AND METHODS: In this cross-sectional study, 17,904 individuals swam 1,000, 1,500, or 3,000 m in cold open water during Sweden's largest open water swimming event in 2018 and 2019. Of 166 swimmers seeking medical attention for acute respiratory symptoms, 160 were included in the study. Medical history, symptoms, and clinical findings were collected. On-site lung ultrasound (LUS) was performed to verify pulmonary edema.

RESULTS: Pulmonary edema was confirmed by LUS in 102 patients (64%); findings were unilateral in 11 (7%). Peripheral oxygen saturation was identified as a strong independent diagnostic test for pulmonary edema, with ≤ 95% as the suggested cut off based on receiver-operating characteristic curve analysis (area under the curve, 0.893; P < .0001). Crackles on lung auscultation, predominantly over the anterior chest, identified 88% of patients with edema. Peripheral oxygen saturation ≤ 95% or auscultation findings of crackles identified pulmonary edema with a sensitivity of 97% and a specificity of 86%. A specificity of 98% and a positive predictive value of 99% for LUS-verified pulmonary edema were reached if patients presented with both oxygen saturation ≤ 95% and auscultation of crackles.

INTERPRETATION: We suggest a clinical algorithm for diagnosis of SIPE for swimmers with acute respiratory symptoms during swimming in cold open water. Novel features of focally distributed edema in the anterior parts of the lungs, sometimes unilateral, add to this unique dataset of an underreported condition.

Place, publisher, year, edition, pages
American College of Chest Physicians , 2020. Vol. 158, no 4, p. 1586-1595
Keywords [en]
SIPE, immersion pulmonary edema, lung ultrasound, swimming, swimming-induced pulmonary edema
National Category
Anesthesiology and Intensive Care General Practice
Identifiers
URN: urn:nbn:se:oru:diva-102242DOI: 10.1016/j.chest.2020.04.028ISI: 000579331500064PubMedID: 32360726Scopus ID: 2-s2.0-85091381565OAI: oai:DiVA.org:oru-102242DiVA, id: diva2:1711174
Note

Funding Agencies:

Center for Clinical Research Dalarna-Uppsala University

Center for Research and Development, Uppsala University/Region Gavleborg

Available from: 2022-11-16 Created: 2022-11-16 Last updated: 2024-03-06Bibliographically approved

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Hårdstedt, MariaSeiler, Claudia

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