Swimming-Induced Pulmonary Edema: A Scoping Review and Analysis of Epidemiology,Pathophysiology,Diagnostics,Management,and Implications for Resource-Limited Care of Patients

Abstract

Background

Swimming-induced pulmonary edema (SIPE) is an underrecognized cause of acute respiratory distress in healthy individuals engaged in open-water activities. Often misdiagnosed or overlooked, SIPE poses significant risks in both athletic and military settings. This review aims to consolidate current understanding of the pathophysiology, clinical presentation, risk factors, and emergency management of SIPE, with an emphasis on evidence relevant to emergency medicine practice.

Methods

A scoping literature review was conducted using PRISMA extension for scoping reviews analysis employing PubMed to identify studies, case reports, and clinical guidelines on SIPE. Data were extracted on proposed pathophysiologic mechanisms, diagnostic strategies, epidemiologic trends, and treatment modalities. Special focus was given to recent research on lung ultrasound, hemodynamic factors, and recurrence prevention.

Results

SIPE is characterized by acute dyspnea, cough, and occasionally hemoptysis during or shortly after swimming, particularly in cold water. Pathophysiology involves increased pulmonary capillary pressures from central blood pooling, cold-induced vasoconstriction, and exercise-driven cardiac output. Risk factors include hypertension, female sex, cold-water exposure, tight wetsuits, and prior episodes of SIPE. Lung ultrasound demonstrates promise as a rapid, noninvasive diagnostic tool. Current management is supportive, focusing on rapid removal from water, oxygen therapy, and, in some cases, positive airway pressure. Despite rapid resolution in most cases, recurrence rates are significant, with long-term preventive strategies still under investigation.

Conclusion

SIPE is a life-threatening but reversible condition requiring heightened awareness in emergency and prehospital settings. Prompt recognition, accurate differentiation from other aquatic and cardiopulmonary emergencies, and appropriate supportive care are critical to favorable outcomes. Further research is essential to develop standardized diagnostic criteria, explore genetic or physiologic predispositions, and guide evidence-based prevention and treatment protocols.