From the Guidelines
Screening for Swimming-Induced Pulmonary Edema (SIPE) should primarily involve a thorough medical history and physical examination focused on risk factors and previous episodes, as there are no specific laboratory tests for SIPE screening. When assessing respiratory fitness for diving or swimming, particular attention should be paid to current respiratory symptoms, previous history of lung disease, and previous episodes of pneumothorax 1. A thorough medical history should include questions about any history of shortness of breath, cough, frothy sputum, or chest tightness during or after swimming, particularly in cold water.
Key Components of Screening
- Medical history focused on respiratory symptoms and previous lung disease
- Physical examination including baseline vital signs, cardiovascular assessment, and pulmonary examination
- Assessment of risk factors such as hypertension, cardiac conditions, overhydration before swimming, and previous SIPE episodes
- Consideration of additional tests like exercise stress testing, echocardiography, or pulmonary function tests for individuals with previous episodes or significant risk factors, although these are not routine 1.
Importance of Early Identification
Early identification of SIPE is crucial as it can be life-threatening if not recognized promptly, and recurrence rates are significant. Individuals with previous episodes should be educated on recognizing early symptoms and the importance of immediate exit from the water if symptoms develop during swimming. While the provided evidence primarily discusses diving 1, the principles of respiratory assessment can be applied to screening for SIPE in swimmers, emphasizing the need for a comprehensive medical evaluation.
From the Research
Screening for Swimming-Induced Pulmonary Edema (SIPE)
To screen for SIPE, the following methods can be employed:
- Medical history: Identifying individuals who have experienced symptoms such as coughing, shortness of breath, and hemoptysis during or after swimming 2, 3, 4
- Physical examination: Checking for signs of pulmonary edema, such as crackles or wheezing, and monitoring oxygen saturation levels 2, 5
- Chest X-Ray or CT scan: To confirm the presence of pulmonary edema, although it may not always be visible on initial imaging 4, 5
- Pulse oximetry: To monitor oxygen saturation levels, which may be decreased in individuals with SIPE 5
- Spirometry: To assess lung function, which may be restrictive in individuals with SIPE 5
- Point-of-care ultrasound (POCUS): To quickly diagnose SIPE in emergency situations 6
Key Findings for Diagnosis
Some key findings that can aid in the diagnosis of SIPE include:
- Acute onset of breathing problems, occasionally accompanied by hemoptysis 4
- Initial hypoxemia, with a mean arterial oxygen saturation of 88.4 +/- 6.6% breathing air 5
- Radiological signs of pulmonary edema on chest X-Ray or CT scan, although these may not always be present 4, 5
- Rapid resolution of symptoms within 48 hours, which is a diagnostic hallmark of SIPE 3, 4