Sophie is a Medical Registrar at the Townsville Hospital. She is currently completing a Masters in Public Health and Tropical Medicine and has a strong interest in the application of this to the practice of internal medicine in Northern Australia.
Immersion Pulmonary Oedema - A Rare But Dangerous Diving-Related Condition
Immersion pulmonary oedema (IPE) is a rare cause of morbidity and mortality in Australia, often associated with diving. This case study presents two cases of IPE in experienced divers managed at the Townsville Hospital.
56 year-old female undertook a single dive to a depth of 12m with maximal time of 20 minutes immersion. Patient resurfaced with a productive cough before becoming unresponsive on the boat. Basic life support (BLS) was performed for 5-10 minutes before responsiveness was regained. She was transferred subsequently to the Townsville Hospital for emergent treatment of suspected cerebral arterial gas embolism (CAGE). The patient deteriorated during hyperbaric treatment, upon which it was discontinued and a diagnosis of IPE made. The patient had an unremarkable recovery in the intensive care unit (ICU).
49 year-old female undertook first dive of trip to depth of 15m with 2 minutes immersion when experienced sudden onset of dyspnoea with cough. Upon resurfacing, patient became unresponsive and BLS performed for 2-3 minutes before regain of responsiveness. She was transferred to the ICU of the Townsville Hospital where she made a swift recovery with the support of non-invasive ventilation.
Immersion pulmonary oedema commonly presents as the sudden onset of dyspnoea and productive cough shortly after immersion. Factors including water immersion, water temperature and exercise increase pulmonary capillary pressures, with failure under stress resulting in alveolar flooding and pulmonary oedema. Treatment is supportive with spontaneous recovery within 24-48 hours, usually with minimal intervention. Episodes can be recurrent and fatal.1
Clinical Practise Point
An understanding of this rare condition is important, particularly for those working in centres with hyperbaric medicine units. Inappropriate management can result in rapid clinical deterioration.
1. Kumar M, Thompson PD. (2018). A Literature Review of Immersion Pulmonary Edema. Phys Sportsmed.doi: 10.1080/00913847.2018.1546104.