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Lambert D, Binkley M, Gaskill Z. Underwater and Scuba Diving Accidents. Emerg Med Clin North Am 2024; 42:551-563. [PMID: 38925774 DOI: 10.1016/j.emc.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
The evaluation and care of an injured scuba diver requires an understanding of the different types of underwater activities that may be deemed scuba diving. Such activities may range from the complex (eg, commercial or technical diving) all the way up to basic recreational scuba or snorkeling. A thorough physical examination should be completed as early as possible with a focus on specific areas at risk for injury and etiology, such as a detailed cardiopulmonary, skin, and neurologic examination. Serial reassessments and supportive care are as equally important as consultation with a dive medicine expert, especially one with hyperbaric capabilities.
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Affiliation(s)
- David Lambert
- Division of Undersea and Hyperbaric Medicine, University of Pennsylvania, 3610 Hamilton Walk, 1 John Morgan Building, Philadelphia, PA 19104, USA.
| | - Mark Binkley
- Division of Undersea and Hyperbaric Medicine, University of Pennsylvania, 3610 Hamilton Walk, 1 John Morgan Building, Philadelphia, PA 19104, USA
| | - Zachary Gaskill
- Division of Undersea and Hyperbaric Medicine, University of Pennsylvania, 3610 Hamilton Walk, 1 John Morgan Building, Philadelphia, PA 19104, USA
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2
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Tello Montoliu A, Olea González A, Pujante Escudero Á, Martínez Del Villar M, de la Guía Galipienso F, Díaz González L, Fernández Olmo R, Freixa-Pamias R, Vivas Balcones D. Cardiovascular considerations on recreational scuba diving. SEC-Clinical Cardiology Association/SEC-Working Group on Sports Cardiology consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:566-573. [PMID: 38580141 DOI: 10.1016/j.rec.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/11/2024] [Indexed: 04/07/2024]
Abstract
The practice of recreational scuba diving has increased worldwide, with millions of people taking part each year. The aquatic environment is a hostile setting that requires human physiology to adapt by undergoing a series of changes that stress the body. Therefore, physical fitness and control of cardiovascular risk factors are essential for practicing this sport. Medical assessment is not mandatory before participating in this sport and is only required when recommended by a health questionnaire designed for this purpose. However, due to the significance of cardiovascular disease, cardiology consultations are becoming more frequent. The aim of the present consensus document is to describe the cardiovascular physiological changes that occur during diving, focusing on related cardiovascular diseases, their management, and follow-up recommendations. The assessment and follow-up of individuals who practice diving with previous cardiovascular disease are also discussed. This document, endorsed by the Clinical Cardiology Association of the Spanish Society of Cardiology (SEC) and the SEC Working Group on Sports Cardiology of the Association of Preventive Cardiology, aims to assist both cardiologists in evaluating patients, as well as other specialists responsible for assessing individuals' fitness for diving practice.
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Affiliation(s)
- Antonio Tello Montoliu
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain.
| | - Agustín Olea González
- Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain; Jefatura de Apoyo Sanitario de Cartagena, Armada Española, Cartagena, Murcia, Spain
| | - Ángel Pujante Escudero
- Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain
| | | | - Fernando de la Guía Galipienso
- Servicio de Cardiología, Policlínica Glorieta Denia, Denia, Alicante, Spain; Clínica Rehabilitación Marina Alta (REMA)/Cardiología Deportiva Denia, Denia, Alicante, Spain; Hospital Clínica Benidorm (HCB), Benidorm, Alicante, Spain
| | - Leonel Díaz González
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Clínica CEMTRO, Madrid, Spain
| | | | - Román Freixa-Pamias
- Servicio de Cardiología, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
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3
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Steele S, Brahmbhatt S, Patel D. Swimming-Induced Pulmonary Edema: Evaluation, Diagnosis, and Treatment. Curr Sports Med Rep 2024; 23:124-129. [PMID: 38578489 DOI: 10.1249/jsr.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT Swimming-induced pulmonary edema (SIPE) is a rare but life-threatening acute illness that can occur in otherwise healthy athletes and individuals. Also known as immersion pulmonary edema, SIPE presents in swimmers, snorkelers, and SCUBA divers. It occurs in persons under heavy exertion in cold water temperatures, leading to coughing, shortness of breath, and sometimes blood-tinged sputum. Under these conditions, there is increased pulmonary vascular pressure, which may ultimately lead to pulmonary edema. This article synthesizes the latest data on the prevalence, pathophysiology, etiology, risks, short- and long-term complications, and the efficacy of supportive medical treatment interventions.
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Affiliation(s)
- Stephen Steele
- Eisenhower Health Sports Medicine Fellowship, George and Julia Argyros Health Center, La Quinta, CA
| | - Sunny Brahmbhatt
- Eisenhower Health Sports Medicine Fellowship, Eisenhower Medical Center, Rancho Mirage, CA
| | - Devak Patel
- Eisenhower Health Sports Medicine Fellowship, Eisenhower Medical Center, Rancho Mirage, CA
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Schmidt T, Reiss N, Olbrich E, Chalabi K, Hagedorn T, Tetzlaff K. Scuba diving after a heart transplant: excessive daring or calculable risk? Am J Physiol Heart Circ Physiol 2023; 325:H569-H577. [PMID: 37477692 DOI: 10.1152/ajpheart.00332.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
Over the past 50 years, outcomes after heart transplantation (HTX) have continuously and significantly improved. In the meantime, many heart transplant recipients live almost normal lives with only a few limitations. In some cases, even activities that actually seemed unreasonable for these patients turn out to be feasible. This article describes the encouraging example of a patient returning to recreational scuba diving after HTX. So far, there were no scientific experiences documented in this area. We worked out the special hemodynamic features and the corresponding risks of this sport for heart transplant recipients in an interdisciplinary manner and evaluated them using the patient as an example. The results show that today, with the appropriate physical condition and compliance with safety measures, a wide range of activities, including scuba diving, are possible again after HTX. They illustrate again the significant development and the enormous potential of this therapy option, which is unfortunately only available to a limited extent.NEW & NOTEWORTHY Example for shared decision-making process for tricky questions: First scientific publication about heart transplantation (HTX)-recipient restarting scuba diving. As exercise physiology after HTX combined with specific diving medicine aspects is challenging, we formed a multidisciplinary team to identify, evaluate, and mitigate the risks involved. The results show that today, with the appropriate physical condition and compliance with safety measures, a wide range of activities are possible again after HTX.
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Affiliation(s)
- Thomas Schmidt
- Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Nils Reiss
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Erk Olbrich
- Department of Cardiac Surgery, INCCI Haerz-Zenter, Luxembourg, Luxembourg
| | - Khaled Chalabi
- Department of Cardiac Surgery, INCCI Haerz-Zenter, Luxembourg, Luxembourg
| | - Thorsten Hagedorn
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Kay Tetzlaff
- Department of Sports Medicine, University Hospital Tuebingen, Tuebingen, Germany
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Hårdstedt M, Seiler C. Swimming-Induced Pulmonary Edema: Respiratory Pathogens as a Potential Risk Factor. Chest 2023; 163:1009-1010. [PMID: 37164569 DOI: 10.1016/j.chest.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Maria Hårdstedt
- Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Vansbro Primary Health Care Center, Vansbro, Sweden.
| | - Claudia Seiler
- Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden
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SCUBA Diving in Adult Congenital Heart Disease. J Cardiovasc Dev Dis 2023; 10:jcdd10010020. [PMID: 36661915 PMCID: PMC9863475 DOI: 10.3390/jcdd10010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023] Open
Abstract
Conventionally, scuba diving has been discouraged for adult patients with congenital heart disease (ACHD). This restrictive sports advice is based on expert opinion in the absence of high-quality diving-specific studies. However, as survival and quality of life in congenital heart disease (CHD) patients have dramatically improved in the last decades, a critical appraisal whether such restrictive sports advice is still applicable is warranted. In this review, the cardiovascular effects of diving are described and a framework for the work-up for ACHD patients wishing to engage in scuba diving is provided. In addition, diving recommendations for specific CHD diagnostic groups are proposed.
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Morin J, Vallée N, Dufresne PL, Rives S, Lehot H, Daubresse L, Roffi R, Druelle A, Cungi PJ, Blatteau JE. Symptomatic or asymptomatic SAR-CoV-2 positive divers should be medically evaluated before returning to scuba diving. Front Physiol 2022; 13:1022370. [DOI: 10.3389/fphys.2022.1022370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: In order to allow the resumption of diving activities after a COVID-19 infection, French military divers are required to undergo a medical fitness to dive (FTD) assessment. We present here the results of this medical evaluation performed 1 month after the infection.Methods: We retrospectively analyzed between April 2020 and February 2021 200 records of divers suspected of COVID-19 contamination. Data collected included physical examination, ECG, blood biochemistry, chest CT scan and spirometry.Results: 145 PCR-positive subjects were included, representing 8.5% of the total population of French military divers. Two divers were hospitalized, one for pericarditis and the other for non-hypoxemic pneumonia. For the other 143 divers, physical examination, electrocardiogram and blood biology showed no abnormalities. However 5 divers (3.4%) had persistent subjective symptoms including fatigability, exertional dyspnea, dysesthesias and anosmia. 41 subjects (29%) had significant decreases in forced expiratory flows at 25–75% and 50% on spirometry (n = 20) or bilateral ground-glass opacities on chest CT scan (n = 24). Only 3 subjects were affected on both spirometry and chest CT. 45% of these abnormalities were found in subjects who were initially asymptomatic or had non-respiratory symptoms. In case of abnormalities, normalization was obtained within 3 months. The median time to return to diving was 45 days (IQR 30, 64).Conclusion: Our study confirms the need for standardized follow-up in all divers after COVID-19 infection and for maintaining a rest period before resuming diving activities.
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Rigler C, Menon G, Lipworth S, Langrish JP, Kipps C, Shanmuganathan M, Smith R. Case Series of Triathletes with Takotsubo Cardiomyopathy Presenting with Swimming-Induced Pulmonary Edema. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:3602505. [PMID: 38655156 PMCID: PMC11022776 DOI: 10.1155/2022/3602505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 08/09/2022] [Indexed: 04/26/2024]
Abstract
Objectives To report three cases of triathletes who presented with swimming-induced pulmonary edema (SIPE) following water immersion. They were subsequently diagnosed with Takotsubo cardiomyopathy (TCM). Design Retrospective case series. Method All cases were recreational athletes competing in mass participation triathlons between June 2018 and 2019. They were initially managed by the event medical team and subsequently at the local tertiary level hospital. Written consent was gained from all the subjects. Results The three triathletes were aged between 50 and 60 years, two were females, and all presented with acute dyspnoea on exiting the water. Two also presented with chest pain and haemoptysis. A diagnosis of SIPE was suspected by the medical event team on initial presentation of low oxygen saturations and clinical signs of pulmonary oedema. All were transferred to the local emergency department and had signs of pulmonary oedema on chest radiographs. Further investigations led to a diagnosis of TCM with findings of T wave inversion in anterolateral electrocardiogram leads and apical hypokinesia on transthoracic echocardiogram and unobstructed coronary arteries. Conclusions This case series presents triathletes diagnosed with SIPE and TCM following the open water swim phase. It is unclear whether the myocardial dysfunction contributed to causation of SIPE or was the result of SIPE. Mass participation race organizers must be prepared that both SIPE and TCM can present in this population. Those presenting with an episode of SIPE require prompt evaluation of their cardiac and pulmonary physiology. Further research is required to ascertain the exact nature of the relationship between TCM and SIPE.
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Affiliation(s)
- Caitlin Rigler
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Gautam Menon
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Samuel Lipworth
- Emergency Department, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jeremy P Langrish
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Courtney Kipps
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Mayooran Shanmuganathan
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ralph Smith
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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9
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Stokes RJ, Sayers R, Sieniewicz BJ, Kim WC. Takotsubo cardiomyopathy findings on cardiac magnetic resonance imaging following immersion pulmonary oedema. Diving Hyperb Med 2022; 52:217-220. [PMID: 36100934 PMCID: PMC9722335 DOI: 10.28920/dhm52.3.217-220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/01/2022] [Indexed: 11/05/2022]
Abstract
Immersion pulmonary oedema (IPO) can affect sea swimmers, snorkelers, and scuba divers. It can be fatal and cases are often mistaken for drowning. There has been an association between IPO and the development of takotsubo cardiomyopathy. We present a case study of a diver rescued from the water with IPO, who was subsequently found to have takotsubo cardiomyopathy on cardiac magnetic resonance imaging (CMR). This case demonstrates CMR findings as well as follow- up investigation results. The diver's and instructor's perspective during the initial dive incident are also described.
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Affiliation(s)
- Rosanna J Stokes
- DDRC Healthcare, Science Park, Plymouth, UK
- Corresponding author: Dr Rosanna J Stokes, DDRC Healthcare, Science Park, Plymouth, UK,
| | | | | | - Wan Cheol Kim
- Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK
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10
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Barouch LA. Swimming-Induced Pulmonary Edema. JACC Case Rep 2022; 4:1094-1097. [PMID: 36124149 PMCID: PMC9481897 DOI: 10.1016/j.jaccas.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Lili A. Barouch
- Address for correspondence: Dr Lili A. Barouch, Johns Hopkins University School of Medicine, Department of Medicine, Division of Cardiology, 5450 Knoll North Drive, Suite 170, Columbia, Maryland 21045, USA. @LiliBarouch
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11
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Tso JV, Powers JM, Kim JH. Response to: Correspondence on 'Cardiovascular considerations for scuba divers' by Wilmshurst et al. Heart 2022; 108:1416-1418. [PMID: 35853685 PMCID: PMC10511218 DOI: 10.1136/heartjnl-2022-321527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jason V Tso
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joshua M Powers
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan H Kim
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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12
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Regnard J, Bouhaddi M, Castagna O, Mourot L. Commentary: The Circulatory Effects of Increased Hydrostatic Pressure Due to Immersion and Submersion. Front Physiol 2022; 13:830759. [PMID: 35153839 PMCID: PMC8829458 DOI: 10.3389/fphys.2022.830759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Jacques Regnard
- EA3920 Prognostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, University of Bourgogne Franche-Comté, Besançon, France
- *Correspondence: Jacques Regnard
| | - Malika Bouhaddi
- Department of Physiology and Functional Testing, University Hospitals of Besançon, EA3920 Prognostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, University of Bourgogne Franche-Comté, Besançon, France
| | - Olivier Castagna
- Underwater Research Team (ERRSO), Military Biomedical Research Institute (IRBA), Toulon, France
- UPR 66312 Human Motricity and Sport Health Expertise Laboratory (LAHMES), Azur Coast Nice University, Nice, France
| | - Laurent Mourot
- EA3920 Prognostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, Exercise Performance Health Innovation (EPHI) Platform, University of Bourgogne Franche-Comté, Besançon, France
- Division for Physical Education, National Research Tomsk Polytechnic University, Tomsk Oblast, Russia
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13
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Global longitudinal strain assessment of cardiac function and extravascular lung water formation after diving using semi-closed circuit rebreather. Eur J Appl Physiol 2022; 122:945-954. [DOI: 10.1007/s00421-022-04887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
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14
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Edge C, Wilmshurst P. Medical conditions that affect the risk of diving. BJA Educ 2021; 21:349-354. [PMID: 34457355 PMCID: PMC8377375 DOI: 10.1016/j.bjae.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- C.J. Edge
- Royal Berkshire NHS Foundation Trust, Reading, UK
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15
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Weenink RP, Wingelaar TT. The Circulatory Effects of Increased Hydrostatic Pressure Due to Immersion and Submersion. Front Physiol 2021; 12:699493. [PMID: 34349668 PMCID: PMC8326965 DOI: 10.3389/fphys.2021.699493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
Increased hydrostatic pressure as experienced during immersion and submersion has effects on the circulation. The main effect is counteracting of gravity by buoyancy, which results in reduced extravasation of fluid. Immersion in a cold liquid leads to peripheral vasoconstriction, which centralizes the circulation. Additionally, a pressure difference usually exists between the lungs and the rest of the body, promoting pulmonary edema. However, hydrostatic pressure does not exert an external compressing force that counteracts extravasation, since the increased pressure is transmitted equally throughout all tissues immersed at the same level. Moreover, the vertical gradient of hydrostatic pressure down an immersed body part does not act as a resistance to blood flow. The occurrence of cardiovascular collapse when an immersed person is rescued from the water is not explained by removal of hydrostatic squeeze, but by sudden reinstitution of the effect of gravity in a cold and vasoplegic subject.
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Affiliation(s)
- Robert P Weenink
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
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16
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Broad individual immersion-scattering of respiratory compliance likely substantiates dissimilar breathing mechanics. Sci Rep 2021; 11:9434. [PMID: 33941815 PMCID: PMC8093428 DOI: 10.1038/s41598-021-88925-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Head-out water immersion alters respiratory compliance which underpins defining pressure at a “Lung centroid” and the breathing “Static Lung Load”. In diving medicine as in designing dive-breathing devices a single value of lung centroid pressure is presumed as everyone’s standard. On the contrary, we considered that immersed respiratory compliance is disparate among a homogenous adult group (young, healthy, sporty). We wanted to substantiate this ample scattering for two reasons: (i) it may question the European standard used in designing dive-breathing devices; (ii) it may contribute to understand the diverse individual figures of immersed work of breathing. Resting spirometric measurements of lung volumes and the pressure–volume curve of the respiratory system were assessed for 18 subjects in two body positions (upright Up, and supine Sup). Measurements were taken in air (Air) and with subjects immersed up to the sternal notch (Imm). Compliance of the respiratory system (Crs) was calculated from pressure–volume curves for each condition. A median 60.45% reduction in Crs was recorded between Up-Air and Up-Imm (1.68 vs 0.66 L/kPa), with individual reductions ranging from 16.8 to 82.7%. We hypothesize that the previously disregarded scattering of immersion-reduced respiratory compliance might participate to substantial differences in immersed work of breathing.
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17
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Vallée N, Rives S, Desruelle AV, Marzetti S, Barchasz V, Risso JJ, Gies V. High Oxygen Consumption in SARS-COV2: Could the Development of Low-Cost Oxygen Rebreather Be Considered? Front Physiol 2021; 11:607913. [PMID: 33584333 PMCID: PMC7873898 DOI: 10.3389/fphys.2020.607913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nicolas Vallée
- Institut de Recherche Biomédicale des Armées_Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Sarah Rives
- Institut de Recherche Biomédicale des Armées_Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Anne-Virginie Desruelle
- Institut de Recherche Biomédicale des Armées_Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | | | | | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées_Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
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18
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Lippmann J, Taylor DM. Medical conditions in scuba diving fatality victims in Australia, 2001 to 2013. Diving Hyperb Med 2020; 50:98-104. [PMID: 32557410 DOI: 10.28920/dhm50.2.98-104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/18/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This study identified pre-existing medical conditions among scuba diving fatalities in Australia from 2001 to 2013, inclusive, and assessed whether these conditions likely contributed to the deaths. METHODS The National Coronial Information System (NCIS) was searched for scuba diving-related cases during 2001-2013, inclusive. Coronial findings, witness and police reports, medical histories, and autopsy and toxicology reports were scrutinised for pre-existing medical conditions and autopsy findings. Predisposing factors, triggers, disabling agents, disabling injuries and causes of death were analysed using a validated template. RESULTS There were 126 scuba diving-related fatalities identified during the study period. Forty-six (37%) divers were identified as having a significant medical condition which may have contributed to their incident. The most common condition was ischaemic heart disease (IHD) which had been diagnosed in 15 of the divers. Thirty-two (25%) deaths were attributed to cardiac disabling injuries (DI) such as ischaemic heart disease and arrhythmias, although a cardiac DI was thought likely in another six. Respiratory conditions were implicated in eight (6%) deaths, at least four associated with cerebral arterial gas embolism. At least 14 (11%) divers who had contributory pre-existing medical conditions had been cleared to dive by a medical practitioner within the year prior. CONCLUSIONS Chronic health-related factors played a major role in almost half of these deaths; primarily cardiac conditions such as IHD and cardiac arrhythmias. Although fitness-to-dive (FTD) assessments have limitations, the high incidence of cardiac-related deaths indicates a need for 'older' divers to be medically assessed for FTD.
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Affiliation(s)
- John Lippmann
- Australasian Diving Safety Foundation, Canterbury, Victoria, Australia.,Department of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Corresponding author: Dr John Lippmann, P.O. Box 478, Canterbury VIC 3126, Australia,
| | - David McD Taylor
- Emergency Department, Austin Hospital, Victoria, Australia.,Department of Medicine, Melbourne University, Victoria, Australia
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19
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Swimming-Induced Pulmonary Edema. Chest 2020; 158:1586-1595. [DOI: 10.1016/j.chest.2020.04.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 12/24/2022] Open
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Sadler C, Alvarez Villela M, Van Hoesen K, Grover I, Lang M, Neuman T, Lindholm P. Diving after SARS-CoV-2 (COVID-19) infection: Fitness to dive assessment and medical guidance. Diving Hyperb Med 2020; 50:278-287. [PMID: 32957131 DOI: 10.28920/dhm50.3.278-287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/14/2020] [Indexed: 01/19/2023]
Abstract
Scuba diving is a critical activity for commercial industry, military activities, research, and public safety, as well as a passion for many recreational divers. Physicians are expected to provide return-to-diving recommendations after SARS-CoV-2 (COVID-19) infection based upon the best available evidence, often drawn from experience with other, similar diseases. Scuba diving presents unique physiologic challenges to the body secondary to immersion, increased pressure and increased work of breathing. The long-term sequelae of COVID-19 are still unknown, but if they are proven to be similar to other coronaviruses (such as Middle East respiratory syndrome or SARS-CoV-1) they may result in long-term pulmonary and cardiac sequelae that impact divers' ability to safely return to scuba diving. This review considers available literature and the pathophysiology of COVID-19 as it relates to diving fitness, including current recommendations for similar illnesses, and proposes guidelines for evaluation of divers after COVID-19. The guidelines are based upon best available evidence about COVID-19, as well as past experience with determination of diving fitness. It is likely that all divers who have contracted COVID-19 will require a medical evaluation prior to return to diving with emphasis upon pulmonary and cardiac function as well as exercise capacity.
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Affiliation(s)
- Charlotte Sadler
- Department of Emergency Medicine, School of Medicine, Division of Hyperbaric Medicine, University of California, San Diego, California, USA.,Corresponding author: Dr Charlotte Sadler, Department of Emergency Medicine, Division of Hyperbaric Medicine, School of Medicine, University of California, San Diego, California, USA,
| | - Miguel Alvarez Villela
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine, Division of Cardiology, Bronx, NY, USA
| | - Karen Van Hoesen
- Department of Emergency Medicine, School of Medicine, Division of Hyperbaric Medicine, University of California, San Diego, California, USA
| | - Ian Grover
- Department of Emergency Medicine, School of Medicine, Division of Hyperbaric Medicine, University of California, San Diego, California, USA
| | - Michael Lang
- Department of Emergency Medicine, School of Medicine, Division of Hyperbaric Medicine, University of California, San Diego, California, USA
| | - Tom Neuman
- Department of Emergency Medicine, School of Medicine, Division of Hyperbaric Medicine, University of California, San Diego, California, USA
| | - Peter Lindholm
- Department of Emergency Medicine, School of Medicine, Division of Hyperbaric Medicine, University of California, San Diego, California, USA
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