Swimming-Induced Pulmonary Edema: A Scoping Review and Analysis of Epidemiology, Pathophysiology, Diagnostics, Management, and Implications for Resource-Limited Care of Patients.
Wilderness & environmental medicine · 2026-02-10 · Scoping review
Abstract
BackgroundSwimming-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.MethodsA 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.ResultsSIPE 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.ConclusionSIPE 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.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
CPAP & NIV · Other drugs · Oxygen · Point-of-care ultrasound
Related articles
- Prehospital treatment modalities for acute exacerbation of chronic obstructive pulmonary disease: a scoping review. (BMC Emerg Med, 2026)
- Early diagnosis and treatment of acute heart failure in prehospital and emergency settings. Part 1 of the International Expert Opinion Series on acute heart failure management. (Eur J Emerg Med, 2025)
- Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure. (ESC Heart Fail, 2020)
- Effects of non-invasive ventilation in patients with acute respiratory failure excluding post-extubation respiratory failure, cardiogenic pulmonary edema and exacerbation of COPD: a systematic review and meta-analysis. (J Anesth, 2017)
- Early non-invasive ventilation for the management of patients with acute respiratory failure: a systematic review and meta-analysis (Signa Vitae, 2026)
- Prehospital airway and ventilatory management: a collaborative and narrative review. (Intensive Care Med, 2026)