Immersion Pulmonary Edema (IPE)

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Marciadive

Registered
Messages
15
Reaction score
4
Location
Massachusetts
# of dives
500 - 999
Diving is my passion. I have been diving over 40 years, am a 66 year old female in excellent shape. On a recent dive I had was unable to breathe when I surfaced from a 65 max depth dive. My dive profile was safe and I felt great the entire dive, until surfacing. Thankfully my buddy was with me. Since it was a drift dive, we had to wait for the boat to find us, give them the distress call, and I was assisted onto the boat. For about 30 minutes I still felt I couldn't get enough air and I was coughing. As time passed, I felt much better; just shaken up. As soon as I got home, I called DAN and they urged me to go to the emergency room because it sounded like possibly pulmonary edema. I did, and ended up admitted for 3 days. Turns out I do have IPE.

Currently I am going though multiple medical tests to try to determine the cause. Apparently, usually more than one thing brings this on. I would love to hear from anyone who has had a similar experience. Additionally, any information about IPE would be appreciated.
 
I am not a medical doctor, so please follow the advise of your doctor.
I only suggest that you are VERY careful before diving again.
A friend of mine had a similar episode, his doctor said that his diving career was finished, he did not accept this, started diving again and he has lost his life in a second episode of pulmonary edema.
A sad history which I whish does not happen again with you.
So please, follow what your doctor says and if he/she says that your are not to dive anymore, it is time to give up.
 
I am not a medical doctor, so please follow the advise of your doctor.
I only suggest that you are VERY careful before diving again.
A friend of mine had a similar episode, his doctor said that his diving career was finished, he did not accept this, started diving again and he has lost his life in a second episode of pulmonary edema.
A sad history which I whish does not happen again with you.
So please, follow what your doctor says and if he/she says that your are not to dive anymore, it is time to give up.
Very difficult, but well said and I agree with you. I have a friend who had two episodes and would not give up. He very nearly died on another dive and is now not diving again and being investigated.
 
Very lucky it did not impact on you till you were out of the water. See my article on my website about the death of a friend via IPE. There are also links to some papers on it.
 
I agree with the others. Definitely follow the advice of your Dr.

I’ve never experienced IPE myself, but have seen it very close. This happened during a training dive for a Deep certification. Incident happened on the first dive of 3 scheduled. Dives 2 and 3 did not occur that day. A total of 4 students and an instructor. Conditions were great for the dive that day.

We did the planned dive down to a max depth of 106 ffw. I was diving EAN 32 and had plenty of NDL time. Site is commonly used for classes and has several platforms, roughly hourglass shape. We had finished some skills done at the 100’ platform, briefly descended to check out some features on the bottom, then began to ascend along the edges of the site. At about 80’, my buddy “L” (relatively new diver in her 60s that I met that day) attempted to bolt for the surface. Instructor was on it, and got her under control. She signaled that she was OK, so we continued with the dive.

We were ascending anyway, and the plan for the remainder was to ascend to the 20’ platform, do an extended safety stop with a couple more skills checks including DSMB deployment. Three of us performed the requested tasks, but L, still signaling OK refused. Instead she just laid down on the platform. When we were done, we did a normal ascent to the surface.

At the surface, things escalated rapidly. As soon as L’s head was above the water, she spat out her regulator and began gasping for breath. I handled her gear while the instructor got her ashore. She was laid down on the shore on her side, and had bloody foam around her mouth. O2 was administered and EMS contacted. They arrived in under 10 minutes. By the time they arrived, she was already starting to improve. She ended up doing a chamber ride as a precaution, but IPE was the diagnosis.

Definitely a scary situation. While I haven’t dove with L since then, I understand she does still dive. I did talk to her when I ran into her after the event. She hadn’t had any further incidents, but as IPE is somewhat unpredictable, and seems to affect women more, it’s still a risk.
 
Diving is my passion. I have been diving over 40 years, am a 66 year old female in excellent shape. On a recent dive I had was unable to breathe when I surfaced from a 65 max depth dive. My dive profile was safe and I felt great the entire dive, until surfacing. Thankfully my buddy was with me. Since it was a drift dive, we had to wait for the boat to find us, give them the distress call, and I was assisted onto the boat. For about 30 minutes I still felt I couldn't get enough air and I was coughing. As time passed, I felt much better; just shaken up. As soon as I got home, I called DAN and they urged me to go to the emergency room because it sounded like possibly pulmonary edema. I did, and ended up admitted for 3 days. Turns out I do have IPE.

Currently I am going though multiple medical tests to try to determine the cause. Apparently, usually more than one thing brings this on. I would love to hear from anyone who has had a similar experience. Additionally, any information about IPE would be appreciated.
@Marciadive , first, I'm sorry to hear this happened and very glad you received prompt help and a diagnosis. Was there anything different about this dive, specifically related to level of exercise and water temperature? Are you a triathlete? If so, how long have you been training?

Also, just so it's asked, was your regulator functioning properly? You mentioned that you felt great for the entire dive so I imagine so but asking to consider/rule out negative pressure pulmonary edema.

Causes of IPE run on a spectrum. Underlying the entire spectrum is the fact that with immersion, the effect of gravity on the fluids in the body disappears, which results in a net increase of blood in the vessels in the torso. Cold water exacerbates this by further shunting blood from the extremities into the torso.

On one extreme end of the spectrum are the triathletes and combat swimmers with exceptionally high cardiac output during exercise, combined with a (likely genetic) predisposition in which the pulmonary arteries do not dilate enough to accommodate the additional blood flow with that cardiac output, which results in pulmonary hypertension (high blood pressure in the pulmonary arteries) and subsequent pulmonary edema during heavy exercise in the water, again exacerbated by cold.

On the other extreme end are people with profound left heart failure who are so affected by immersion that additional blood that shifts into the torso could cause pulmonary edema. Most of those people are not able to dive.

A lot of IPE cases are likely a mix of these: an underlying predisposition for IPE, cold water, heavy exercise, and possibly subclinical cardiac conditions that probably wouldn't declare themselves outside of swimming or diving.

Hopefully a cardiac workup, possibly including ultrasound and stress testing, is part of your plan of care. That would help rule out cardiac causes. Beyond that, people who have experienced IPE are very likely to experience it again, as other posters have noted.

The hyperbaric unit at the Massachusetts Eye and Ear Infirmary has physicians who are trained and experienced in evaluating divers. If you haven't been in touch with them already, I'd recommend you do so. Will DM contact info.

Best regards,
DDM
 
I experienced IPE during two boat dives in Cozumel. I was 65 at the time and in very good health. I was a scuba instructor, diving for 30 years, and had never experienced any problems during any of my dives. The first dive was about 70 feet for about 30 minutes followed by a 5 minute stop at 15 feet. I had a slight cough while on my surface interval that was annoying, but didnt set off any alarms. After an hour surface interval I went back in the water, this time to about 60 feet for 30 minutes. My coughing increased during the dive, and I felt myself coughing up fluids. It became increasingly difficult to breathe, so after a 5minute safety stop I boarded the boat. I informed the dive leader of the problem and he told me to head to the hospital when we landed. I drove myself to the hospital, was examined and told I had immersion edema. I had to spend the night at the hospital, was given a diuretic, and watched for 24 hours. The doctor told me not to dive again. It was the hardest thing I've ever done, but I have not dove since. I still snorkel, but since that was the only time in my life I've ever been in a hospital and dont want that experience again, I have decided my diving is over.
My blood pressure at the hospital was very high, and the doctor informed me that probably worsened the situation.
 

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