Restricted accessResearch articleFirst published online 2026
Swimming-Induced Pulmonary Edema: A Scoping Review and Analysis of Epidemiology,Pathophysiology,Diagnostics,Management,and Implications for Resource-Limited Care of Patients
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.
SmithROrmerodJOMSabharwalNKippsC. Swimming-induced pulmonary edema: current perspectives. Open Access J Sports Med.2018;9:131-137.
4.
BanhamNSmartDWilmshurstPMitchellSJTurnerMSBrysonP. Joint position statement on immersion pulmonary oedema and diving from the South Pacific Underwater Medicine Society (SPUMS) and the United Kingdom Diving Medical Committee (UKDMC) 2024. Diving Hyperb Med.2024;54:344-349.
5.
WilmshurstPNuriMCrowtherABettsJWebbpeploeM. Forearm vascular responses in subjects who develop recurrent pulmonary edema when scuba diving—a new syndrome. Br Heart J.1981;49(1).
6.
Keuski BM, US Navy Experimental Diving Unit. The Incidence of Swimming-Induced Pulmonary Edema (SIPE) in Trainees at US Navy Dive Training Facilities. Accessed April 7, 2025. https://apps.dtic.mil/sti/citations/ADA561894
7.
ShupakAWeiler-RavellDAdirYDaskalovicYIRamonYKeremD. Pulmonary oedema induced by strenuous swimming: a field study. Respir Physiol.2000;121:25-31.
8.
CochardGHenckesADeslandesSet al.Swimming-induced immersion pulmonary edema while snorkeling can be rapidly life-threatening: case reports. Undersea Hyperb Med.2013;40(5):411-416.
9.
WengerMRussiEW. Aqua jogging-induced pulmonary oedema. Eur Respir J.2007;30:1231-1232.
10.
HårdstedtMKristianssonLSeilerCBraman ErikssonASundhJ. Incidence of swimming-induced pulmonary edema. Chest. 2021;160:1789-1798.
BergstedtDMankaLOlinJTLiJGeorgeMP. Swimming induced pulmonary edema: a case report and review of the literature. In: C57. Medical Mysteries Unveiled: Case Reports Highlighting Rare Respiratory Conditions. American Thoracic Society; 2024:A6003.
13.
MoonREMartinaSDPeacherDFKrausWE. Deaths in triathletes: immersion pulmonary oedema as a possible cause. BMJ Open Sport Exerc Med. 2016;2:e000146.
14.
RayKWilliamsSMorricalSGarbinoAHongMSandersR.Pulmonary fluid shifts occur as a result of scuba diving at NASA’s Neutral Buoyancy Lab. Undersea Hyperb Med. 2020;47(4):531-537.
15.
IllidiCRStangJMelauJHisdalJStensrudT. Does cold-water endurance swimming affect pulmonary function in healthy adults?Sports.2021;9:7.
16.
SpencerSDickinsonJForbesL. Occurrence, risk factors, prognosis and prevention of swimming-induced pulmonary oedema: a systematic review. Sports Med Open. 2018;4:43.
17.
YoderJAVieraAJ. Management of swimming-induced pulmonary edema. Am Fam Physician. 2004;69(5):1046-1049.
18.
SmithRBrookeDKippsCSkariaBSubramaniamV. A case of recurrent swimming-induced pulmonary edema in a triathlete: the need for awareness. Scand J Med Sci Sports. 2017;27:1130-1135.
19.
MorishimaRNakashimaKSuzukiSYamamiNAoshimaM. A diver with immersion pulmonary oedema and prolonged respiratory symptoms. Diving Hyperb Med.2018;48:259-261.
20.
SanouAZMurrayRLHernandezESherrierD. An unusual presentation of pulmonary edema during an ice dive at altitude. Mil Med.2023;188:392-397.
21.
BeinartRMatetzkySAradTHodH. Cold water-induced pulmonary edema. Am J Med.2007;120:e3.
22.
EvainFLougePPignelRFracassoTRouyerF. Fatal diving: could it be an immersion pulmonary edema? Case report. Int J Legal Med.2022;136:713-717.
23.
VinkelJBakPJuel Thiis KnudsenPHyldegaardO. Forensic case reports presenting immersion pulmonary edema as a differential diagnosis in fatal diving accidents. J Forensic Sci.2018;63:299-304.
24.
MorimotoNTanabeMImonoA, Otani M, Shioji S, Hirasawa S, et al.Immersion pulmonary edema in a patient on maintenance dialysis: a case report. Semin Dial.2020;33:178-181.
25.
MahonRTKerrSAmundsonDParrishJS. Immersion pulmonary edema in special forces combat swimmers. Chest. 2002;122:383-384.
26.
EdmondsCLippmannJBoveA. Immersion pulmonary edema: an analysis of 31 cases from Oceania. Undersea Hyperb Med.2019;46:603-610.
27.
EdmondsCLippmannJFockA. Immersion pulmonary edema: case reports from Oceania. Undersea Hyperb Med. 2019;46:581-601.
CastagnaOde MaistreSSchmidBCaudalDRegnardJ. Immersion pulmonary oedema in a healthy diver not exposed to cold or strenuous exercise. Diving Hyperb Med. 2018;48:40-44.
30.
DavisGCzarnikJEvansJMcGraneOL.Critical hypophosphatemia in a special operations combat dive candidate: A case report. JSOM. Summer2023;23(2):107-109. https://www.jsomonline.com/Citations/PMWA-GHDT.php
31.
MiyazawaRMoritaYOkajimaYMatsusakoMKuriharaY. Marathon-induced pulmonary edema of a patient with transient dyspnea. Jpn J Radiol.2015;33:675-677.
32.
MehtaSRSrinivasanKVBindraMSKumarMRLahiriAK. Near drowning in cold water. J Assoc Physicians India. 2000;48(7):674-676.
LippmannJWalkerDLawrenceCLFockAWodakTJamiesonS. Provisional report on diving-related fatalities in Australian waters 2007. Diving Hyperb Med.2012;42(3):151-170.
35.
LippmannJLawrenceCFockAJamiesonSHarrisR. Provisional report on diving-related fatalities in Australian waters in 2011. Diving Hyperb Med.2016;46(3):207-240.
36.
SladeJBJHattoriTRayCSBoveAACianciP. Pulmonary edema associated with scuba diving: case reports and review. Chest. 2001;120:1686–1694.
37.
CochardGArvieuxJLacourJMMadouasG. Pulmonary edema in scuba divers: recurrence and fatal outcome. Undersea Hyperb Med.2005;32(1):39-44.
38.
BiswasRShibuPKJamesCM. Pulmonary oedema precipitated by cold water swimming. Br J Sports Med.2004;38:e36.
39.
GnadingerCAColwellCBKnautAL. Scuba diving-induced pulmonary edema in a swimming pool. J Emerg Med.2001;21:419-421.
40.
RoegglaMRoegglaGSeidlerDMuellnerMLaggnerAN. Self-limiting pulmonary edema with alveolar hemorrhage during diving in cold water. Am J Emerg Med.1996;14:333.
41.
WagnerMEYuELussierALinNGuoHLindholmP. Serial chest computed tomography imaging in a freediver with a case of pulmonary barotrauma of descent (lung squeeze) showing the time course of resolution. Diving Hyperb Med.2025;55:271-274.
42.
MatthewATBoswellGSebrerosB. Simultaneous presentation of swimming-induced pulmonary edema in a set of monozygotic twin elite maritime warfare candidates: a novel case report. Mil Med.2025;190:e862-e868.
43.
LundKLMahonRTTanenDABakhdaS. Swimming-induced pulmonary edema. Ann Emerg Med.2003;41:251-256.
44.
O’KeefeCLClemente FuentesRWSalinasE. Swimming-induced pulmonary edema in a member participating in a special tactics selection course. Aerosp Med Hum Perform.2024;95:937-939.
45.
KwekWSeahMChowW. Swimming-induced pulmonary edema in a tropical climate: a case report. Undersea Hyperb Med.2017;44:293-296.
46.
HaranJBDonaldsonCKickerPW. Swimming-induced pulmonary edema in an active-duty female triathlete. Mil Med.2020;185:e1897-e1899.
47.
WilmshurstP. Swimming-induced pulmonary edema: a Swedish experience. Chest. 2022;162:277-278.
48.
AdirYShupakAGilA, Peled N, Keynan Y, Domachevsky L, et al.Swimming-induced pulmonary edema: clinical presentation and serial lung function. Chest.2004;126(2):394-399.
49.
CaseyHDastidarAGMacIverD. Swimming-induced pulmonary oedema in two triathletes: a novel pathophysiological explanation. J R Soc Med.2014;107:450-452.
50.
SmartDRSageMDavisFM. Two fatal cases of immersion pulmonary oedema—using dive accident investigation to assist the forensic pathologist. Diving Hyperb Med.2014;44(2):97–100.
51.
VolkCSpiroJBoswellG, Lindholm P, Schwartz J, Wilson Z, et al.Incidence and impact of swimming-induced pulmonary edema on navy SEAL candidates. Chest.2021;159(5):1934-1941.
52.
SebrerosBAWisniewskiPLindholmPBoswellGEVolkCG. Incidence of respiratory pathogens in naval special warfare sea, air, and land team candidates with swimming-induced pulmonary edema. Chest.2023;163:1185-1192.
53.
MillerCCCalder-BeckerKModaveF. Swimming-induced pulmonary edema in triathletes. Am J Emerg Med.2010;28:941-946.
54.
WeeninkRPWingelaarTT. Swimming-induced pulmonary edema: new data sheds a light on true incidence. Chest.2021;160:1594-1595.
55.
HårdstedtMSeilerC. Swimming-induced pulmonary edema: respiratory pathogens as a potential risk factor. Chest.2023;163:1009-1010.
56.
GemppEDemaistreSLougeP. Hypertension is predictive of recurrent immersion pulmonary edema in scuba divers. Int J Cardiol.2014;172:528-529.
57.
PeacherDFMartinaSDOtteniCEWesterTEPotterJFMoonRE. Immersion pulmonary edema and comorbidities: case series and updated review. Med Sci Sports Exerc.2015;47:1128-1134.
58.
BeckTPTsipisNKissloJARiveraJDArmourACMoonRE. Immersion-induced mitral regurgitation: a novel risk factor for swimming-induced pulmonary edema. Chest.2022;161:e137-e143.
59.
HalpernPGefenASorkinePEladD. Pulmonary oedema in SCUBA divers: pathophysiology and computed risk analysis. Eur J Emerg Med.2003;10:35-41.
60.
Henckes A, Cochard G, Gatineau F, Louge P, Gempp E, Demaistre D, et al. Risk factors for immersion pulmonary edema in recreational scuba divers: a case–control study. Undersea Hyperb Med. 2019;46(5):611–618.
61.
FraserJAVPeacherDFFreibergerJJ, Natoli MJ, Schinazi EA, Beck IV, et al.Risk factors for immersion pulmonary edema: hyperoxia does not attenuate pulmonary hypertension associated with cold water-immersed prone exercise at 4.7 ATA. J Appl Physiol (1985).2011;110(3):610-618.
62.
DruelleAMouhatBZbitouOCastagnaO. Static immersion and negative static lung load-induced right ventricle systolic function adaptation: a risk factor for immersion pulmonary edema. Chest.2024;166:532-543.
63.
ZavorskyGSAnholmJDBoussugesA, et al.Comments on point:counterpoint: Pulmonary edema does/does not occur in human athletes performing heavy sea-level exercise. J Appl Physiol.2010;109(4):1276-1280.
64.
Grunig H, Nikolaidis P, Moon RE, Knechtle B. Diagnosis of swimming induced pulmonary edema—a review. Front Physiol. 2017;8. https://doi.org/10.3389/fphys.2017.00652
65.
AlonsoJVChowdhuryMBorakatiRGankandeU. Swimming-induced pulmonary oedema an uncommon condition diagnosed with POCUS ultrasound. Am J Emerg Med.2017;35:1986.e3-e4.
66.
Carter EA, Koehle MS. Immersion pulmonary edema in female triathletes. Pulm Med. 2011:2011:261404.
67.
TarozziIFranceschettiLSimoniniGRaddiSMachadoDBugelliV. Black box of diving accidents: contribution of forensic underwater experts to three fatal cases. Forensic Sci Int.2023;346:111642.
68.
CorgieLHuibanNPontierJ-MBrocqF-XBoulardJ-FMonteilM. Diving accident evacuations by helicopter and immersion pulmonary edema. Aerosp Med Hum Perform.2020;91:806-811.
69.
WinklewskiPJKotJFrydrychowskiAFNuckowskaMK. Effects of diving and oxygen on autonomic nervous system and cerebral blood flow. Diving Hyperb Med.2013;43(3):148-156.
70.
SadlerCLussierAGroverIVan HoesenKLindholmP. Medical examination of divers after COVID-19 infection: a prospective, observational study using published (original and revised) guidelines for evaluation. Diving Hyperb Med.2024;54:176-183.
71.
HampsonNBDunfordRG. Pulmonary edema of scuba divers. Undersea Hyperb Med.1997;24(1):29-33.
72.
van OoijP-Jvan HulstRA. Respiratory fitness for occupational diving, what is new?. Undersea Hyperb Med.2025;52(1):33-40.
73.
EdmondsC. Response to Dr. Davis’ letter: Immersion pulmonary edema—facts and fancies. Undersea Hyperb Med.2016;43(6):745-746.
74.
Valdivia-ValdiviaJMRäisänen-SokolowskiALindholmP. Prolonged syncope with multifactorial pulmonary oedema related to dry apnoea training: safety concerns in unsupervised dry static apnoea. Diving Hyperb Med.2021;51:210-215.
75.
AllingerJMelikovOLemaîtreF. Trends in competitive freediving accidents. Diving Hyperb Med.2024;54:301-307.
76.
RegnardJVeil-PicardMBouhaddiMCastagnaO. A neoprene vest hastens dyspnoea and leg fatigue during exercise testing: entangled breathing and cardiac hindrance?Diving Hyperb Med.2021;51:376-381.
77.
LudwigBBMahonRTSchwartzmanEL. Cardiopulmonary function after recovery from swimming-induced pulmonary edema. Clin J Sport Med.2006;16:348-351.
78.
AymeKRossiPGavarryOChaumetGBoussugesA. Cardiorespiratory alterations induced by low-intensity exercise performed in water or on land. Appl Physiol Nutr Metab.2015;40:309-315.
79.
BoveAA. Cardiovascular concerns in water sports. Clin Sports Med.2015;34:449-460.
80.
CastagnaOGemppEPoyetR, Schmid B, Desruelle AV, Crunel V, et al.Cardiovascular mechanisms of extravascular lung water accumulation in divers. Am J Cardiol.2017;119(6):929-932.
81.
WesterTECherryADPollockNW, Freiberger JJ, Natoli MJ, Schinazi EA, et al.Effects of head and body cooling on hemodynamics during immersed prone exercise at 1 ATA. J Appl Physiol (1985).2009;106(2):691-700.
82.
PeacherDFPecorellaSRHFreibergerJJ, Natoli MJ, Schinazi EA, Doar PO, et al.Effects of hyperoxia on ventilation and pulmonary hemodynamics during immersed prone exercise at 4.7 ATA: possible implications for immersion pulmonary edema. J Appl Physiol (1985).2010;109(1):68-78.
83.
BoussugesAGavarryOBessereauJCoulangeMBourc’hisMRossiP. Glossopharyngeal insufflation and breath-hold diving: the more, the worse?Wilderness Environ Med.2014;25:466-471.
84.
Tunstall PedoeD. Heart or lung failure: what causes exertional, high altitude, and cold immersion pulmonary oedema?Br J Sports Med.1995;29:218-220.
85.
HenckesAArvieuxJCochardGJézéquelPArvieuxCC. Hemoptysis and pneumomediastinum after breath-hold diving in shallow water: a case report. Undersea Hyperb Med.2011;38(3):213-216.
DavisFM. Immersion pulmonary edema—facts and fancies. Undersea Hyperb Med.2016;43(6):744-745.
88.
MoonRE. Immersion pulmonary edema: drowning from the inside. Undersea Hyperb Med.2019;46(5):577-599.
89.
ShearerDMahonRT. Brain natriuretic peptide level In six basic underwater demolitions/SEAL recruits presenting with swimming induced pulmonary edema (SIPE). JSOM Summer2025;09(2):44-50.
90.
BoveAA. Pulmonary aspects of exercise and sports. Methodist Debakey Cardiovasc J.2016;12:93-97.
91.
Coulange M, Rossi P, Gargne O, Bessereau J, Regnard J, Jammes Y, et al. Pulmonary oedema in healthy SCUBA divers: new physiopathological pathways.Clin Physiol Funct Imaging. 2010;30(3):181–186.
92.
Kristainsson L, Seiler C, Lundeqvist D, Eriksson AB, Sundh J, Hardstedt M. Symptom duration, recurrence, and long-term effects of swimming-induced pulmonary edema. Chest. 2023;164(5):1257–1267.
93.
JepsonNRienksRSmartDBennettMHMitchellSJTurnerM. South Pacific Underwater Medicine Society guidelines for cardiovascular risk assessment of divers. Diving Hyperb Med.2020;50:273-277.
94.
KumarMThompsonPD. A literature review of immersion pulmonary edema. Phys Sportsmed.2019;47:148-151.
95.
MoonREBeckTP. Cold water, hard swim, shortness of breath: how to assess?Chest.2020;158:1329-1330.
96.
LippmannJLawrenceCFockA. Compressed gas diving fatalities in Australian waters 2014 to 2018. Diving Hyperb Med.2023;53:76-84.
97.
Gempp E, Louge P, Blatteau JE, Hugon M, Descriptive epidemiology of 153 diving injuries with rebreathers among French military divers from 1979 to 2009. Mil Med. 2011;176(4);446–450.
98.
MahonRT. Exploring the depths of immersion pulmonary edema. J Appl Physiol (1985).2011;110:589-590.
99.
AsplundCACreswellLL. Hypothesised mechanisms of swimming-related death: a systematic review. Br J Sports Med.2016;50:1360-1366.
100.
Sai TinSWiwanikitV. Immersion pulmonary oedema and diving fatalities. Diving Hyperb Med.2014;44(3):175.
101.
KoehleMSLepawskyMMcKenzieDC. Pulmonary oedema of immersion. Sports Med.2005;35:183-190.
102.
SteeleSBrahmbhattSPatelD. Swimming-Induced pulmonary edema: evaluation, diagnosis, and treatment. Curr Sports Med Rep.2024;23:124-129.
103.
MoonRE. Swimming-induced pulmonary edema: imperative to follow-up. Chest.2023;164:1077-1078.
104.
KnutsonT. Swimming-induced pulmonary oedema—a hazard in intensive military training?J R Army Med Corps.2010;156:258-259.
105.
KochARadermacherPKönigsteinKKählerWWerrHKlapaS. The immersion-induced pulmonary edema in swimming and diving. Dtsch Z Sportmed.2024;75(6):231-236.
106.
KeuskiBM. Updates in diving medicine: evidence published in 2017–2018. Undersea Hyperb Med.2018;45:511-520.
107.
DemoulinRPoyetRCastagnaO, Gempp E, Druelle A, Schmitt P, et al.Epidemiological, clinical, and echocardiographic features of twenty “Takotsubo-like” reversible myocardial dysfunction cases with normal coronarography following immersion pulmonary oedema. Acta Cardiol.2021;76(3):296-302.
108.
AgostoniPCattadoriGBianchiMWassermanK. Exercise-induced pulmonary edema in heart failure. Circulation.2003;108:2666-2671.
109.
Wilmhurst PT. Immersion pulmonary oedema: a cardiological perspective. Diving Hyperb Med. 2019;49(1):30–40.
110.
OldmanJMorwoodSWillisJAugustineDX. Myocardial oedema in the setting of immersion pulmonary oedema—cause or effect?BMJ Case Rep.2023;16:e251274.
111.
LougePCoulangeMBenetonF, Gempp E, Le Pennetier O, Algoud M, et al.Pathophysiological and diagnostic implications of cardiac biomarkers and antidiuretic hormone release in distinguishing immersion pulmonary edema from decompression sickness. Medicine (Baltimore).2016;95(26):e4060.
112.
GemppELougePHenckesA, Demaistre S, Heno P, Blatteau JE.Reversible myocardial dysfunction and clinical outcome in scuba divers with immersion pulmonary edema. Am J Cardiol.2013;111(11):1655-1659.
113.
StokesRJSayersRSieniewiczBJKimWC. Takotsubo cardiomyopathy findings on cardiac magnetic resonance imaging following immersion pulmonary oedema. Diving Hyperb Med.2022;52:217-220.
114.
VermaeteIMuyldermansL. The perils of intense exercise: swimming-induced pulmonary oedema. Acta Cardiol.2018;73:314-315.
115.
MarlingeMDeharoPJouliaF, Coulange M, Vairo D, Gaudry M, et al.Troponins in scuba divers with immersion pulmonary edema. Biosci Rep. 2018;38(5):BSR20181024.
116.
Yoder JA, Viera AJ. Management of swimming-induced pulmonary edema. Am Fam Physician. 2004;69(5):1046, 1048-1049.
117.
Martina SD, Freiberger JJ, Peacher DF, Natoli MJ, Schinazi EA, Kernagis DN, et al. Sildenafil: possible prophylaxis against swimming-induced pulmonary edema. Med Sci Sports Exerc. 2017;49(9):1755-1757.
118.
Ruggeri P, Glossop A, Esquinas AM. Prehospital management of swimming-induced pulmonary edema. Chest. 2022;162(2):E108-E109.
SeilerCKristianssonLKlingbergC, Sundh J, Eriksson AB, Lundeqvist D, et al.Swimming-induced pulmonary edema: evaluation of prehospital treatment with CPAP or positive expiratory pressure device. Chest.2022;162(2):410-420.
121.
MoonREMartinaSDPeacherDF, Potter JF, Wester TE, Cherry AD, et al.Swimming-induced pulmonary edema: pathophysiology and risk reduction with sildenafil. Circulation.2016;133(10):988-996.
122.
SteinsH. Altitude, Ultrasound, and Austere Medicine: A Prospective Study of Swimming-Induced Pulmonary Edema In Endurance Athletes [Master’s thesis]. Rocky Vista University;2025.
123.
PonsMBlickenstorferDOechslinE, Hold G, Greminger P, Franzeck UK, et al.Pulmonary oedema in healthy persons during scuba-diving and swimming. Eur Respir J.1995;8(5):762-767.
124.
HampsonNBDunfordRG. Pulmonary edema of scuba divers. Undersea Hyperb Med. 1997;(1):29–33.
125.
Schoene RB.Schoene. Pulmonary edema at high altitude: review, pathophysiology, and update. Clin Chest Med. 1985;6(3):491-507.
126.
Mayr U, Lukas M, Habenicht L, Wiessner J, Heilmaier M, Ulrich J, et al. B-lines scores derived from lung ultrasound provide accurate prediction of extravascular lung water index: an observational study in critically ill patients. J Intensive Care Med. 2022;37(1):21-31.
127.
TheerawitPToumanNSutherasanYKiatboonsriS. Transthoracic ultrasound assessment of B-lines for identifying the increment of extravascular lung water in shock patients requiring fluid resuscitation. Indian J Crit Care Med.2014;18:195-199.
128.
SoldatiGDemiMDemiL. Ultrasound patterns of pulmonary edema. Ann Transl Med.2019;7:S16.
129.
TewariKPelluruSMishraD, Pahuja N, Mohapatra AR, Sharma J, et al.Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: a single centre, prospective, observational study. Open J Anesthesiol.2024;14(3):41-50.
130.
CardinaleLPriolaAMMorettiFVolpicelliG. Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure. World J Radiol.2014;6:230-237.
131.
RanaRVlahakisNEDanielsCE, Jaffe AS, Klee GG, Hubmayr RD, et al.B-type natriuretic peptide in the assessment of acute lung injury and cardiogenic pulmonary edema. Crit Care Med.2006;34(7):1941-1946.
132.
PazPMakramJMallahHMantillaBBallSNugentK. Swimming-induced pulmonary edema. Proc (Bayl Univ Med Cent).2020;33(3):409-412.
133.
WilmshurstP. Immersion pulmonary oedema: a cardiological perspective. Diving Hyperb Med.2019;49:30-40.
134.
CarterEAKoehleMS. Immersion pulmonary edema in female triathletes. Pulm Med.2011;2011:261404.
135.
KristianssonLSeilerCLundeqvistDBraman ErikssonASundhJHårdstedtM. Symptom duration, recurrence, and long-term effects of swimming-induced pulmonary edema: a 30-month follow-up study. Chest.2023;164:1257-1267.
136.
ShearerDMahonRT. Brain natriuretic peptide levels in six basic underwater demolitions/SEAL recruits presenting with swimming induced pulmonary edema (SIPE). J Spec Oper Med.2009;9:44-50.
137.
AttinàTMMalatinoLSMaxwellSRPadfieldPLWebbDJ. Phosphodiesterase type 5 inhibition reverses impaired forearm exercise-induced vasodilatation in hypertensive patients. J Hypertens.2008;26:501-507.
138.
RoseguiniBTHiraiDMAlencarMC, Ramos RP, Silva BM, Wolosker N, et al.Sildenafil improves skeletal muscle oxygenation during exercise in men with intermittent claudication. Am J Physiol Regul Integr Comp Physiol.2014;307(4):R396-R404.
MichelCCWoodcockTECurryF-RE. Understanding and extending the starling principle. Acta Anaesthesiol Scand.2020;64:1032-1037.
141.
JdidiHDuguéBde BisschopCDupuyODouziW. The effects of cold exposure (cold water immersion, whole- and partial-body cryostimulation) on cardiovascular and cardiac autonomic control responses in healthy individuals: a systematic review, meta-analysis and meta-regression. J Therm Biol.2024;121:103857.
142.
CurrieKDCoatesAMSlyszJT, Aubry RL, Whinton AK, Mountjoy ML, et al.Left ventricular structure and function in elite swimmers and runners. Front Physiol.2018;9:1700.
143.
TetzlaffKSwensonERBärtschP. An update on environment-induced pulmonary edema—“when the lungs leak under water and in thin air.”Front Physiol.2022;13:1007316.
144.
IkäheimoTM. Cardiovascular diseases, cold exposure and exercise. Temperature (Austin).2018;5:123-146.
145.
GarbellaECatapanoGPrataliLPingitoreA. Pulmonary edema in healthy subjects in extreme conditions. Pulm Med.2011;2011:275857.
146.
PradoA. The Wetsuit Effect: Physiological Response to Wearing a Wetsuit [MSc thesis]. UNLV Theses, Dissertations, Professional Papers, and Capstones; 2014. https://doi.org/10.34917/6456435
147.
GroellerH. The Effects of Wearing a Wetsuit on the Thermoregulatory and Cardiovascular Responses Observed During a Triathlon in Elite Male Competitors [Dissertation]. University of Wollongong; 2024.
AdirYBoveAA. Lung injury related to extreme environments. Eur Respir Rev.2014;23:416-426.
151.
Weiler-RavellDShupakAGoldenbergI, Halpern P, Shoshani O, Hirschhorn G, et al.Pulmonary oedema and haemoptysis induced by strenuous swimming. Br Med J.1995;311(7001):361-362.
152.
HohmannEGlattVTetsworthK. Swimming induced pulmonary oedema in athletes—a systematic review and best evidence synthesis. BMC Sports Sci Med Rehabil.2018;10:18.
153.
SmithBJ. The biomechanics of SIPE and squeeze: lessons learned from acute and ventilator induced lung injury. In: Lindholm P, Lang MA, Tillmans F, eds. Barotrauma and SIPE in Freediving. Proceedings of the San Diego Center of Excellence in Diving/Divers Alert Network 2023 Oct 27–28 Workshop. Divers Alert Network; 2024. https://emergencymed.ucsd.edu/_files/divisions/sdced/2024-sdceddan_workshop_proceedings_2024.pdf
154.
ShapiroKAPhillipsTCDineenEH, Taylor BJ.The heart underwater: mechanisms and treatments of immersion pulmonary edema. Curr Treat Options Cardio Med.2025;27(1):19.
155.
MartinaSDFreibergerJJPeacherDF, Natoli MJ, Schinazi EA, Kernagis DN, et al.Sildenafil: possible prophylaxis against swimming-induced pulmonary edema. Med Sci Sports Exerc.2017;49(9):1755-1757.
156.
ClarkSTSheratonM. EMS high-altitude field prophylaxis and treatmentStatPearls [Internet]. StatPearls Publishing; 2025:1-5.
157.
BartschPMaggioriniMRitterMNotiCVockPOelzO. Prevention of high-altitude pulmonary edema by nifedipine. N Engl J Med. 1991;325:1284-1289.
158.
MaloPEWassermanMA. The effect of calcium antagonists on histamine and leukotriene-induced tracheal microvascular permeability in the Guinea pig. Prostaglandins.1986;32:221-233.
159.
KobayashiTKoyamaSKuboKFukushimaMKusamaS. Clinical features of patients with high-altitude pulmonary edema in Japan. Chest.1987;92:814-821.
160.
HackettPHBertmanJRodriguezGTenneyJ. Pulmonary edema fluid protein in high-altitude pulmonary edema. JAMA.1986;256:36.
GaoDWangYZhangRZhangY. Efficacy of acetazolamide for the prophylaxis of acute mountain sickness: a systematic review, meta-analysis and trial sequential analysis of randomized clinical trials. Am J Med Sci.2021;361:635-645.
163.
SartoriCDuplainHLeporiM, Egli M, Maggiorini M, Nicod P, et al.High altitude impairs nasal transepithelial sodium transport in HAPE-prone subjects. Eur Respir J.2004;23(6):916-920.
164.
MaggioriniMBrunner-La RoccaH-PPethS, Fischler M, Bohm T, Bernheim A, et al.Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Ann Intern Med.2006;145(7):497-506.
165.
BurtscherJGattererHBeidlemanBABurtscherM. Dexamethasone for prevention of AMS, HACE, and HAPE and for limiting impairment of performance after rapid ascent to high altitude: a narrative review. Mil Med Res.2025;12:48.
166.
GrünigHNikolaidisPTMoonREKnechtleB. Diagnosis of swimming induced pulmonary edema—a review. Front Physiol.2017;8:652.
