Abstract
BackgroundThe risk factors of pulmonary edema induced by diving in healthy subjects are not well known. The aim of the present study was to assess the parameters contributing to the increase in extravascular lung water after diving.MethodsThis study was carried out in a professional diving institute. All divers participating in the teaching program from June 2012 to June 2014 were included in the study. Extravascular lung water was assessed using the detection of ultrasound lung comets (ULC) by chest ultrasonography. Clinical parameters and dive profiles were recorded using a questionnaire and a dive computer.ResultsOne-hundred six divers were investigated after 263 dives. They used an open-circuit umbilical supplying compressed gas diving apparatus in 202 cases and a self-contained underwater breathing apparatus in 61 cases. A generalized linear mixed model analysis was performed which demonstrated that the dive induced a significant increase in ULC score (incidence rate ratio: 3.16). It also identified that the predictive variable of increased extravascular lung water after the dive was the exercise intensity at depth (z = 3.99, p < 0.0001). The other parameters studied such as the water temperature, dive profile, hyperoxic exposure, or anthropometric data were not associated with the increase in extravascular lung water after the dive.ConclusionsIn this study, the exercise intensity was the main contributor to the increase in extravascular lung water in healthy divers. To improve the prevention of immersion pulmonary edema, the exercise intensity experienced during the dive should thus be adapted to the aerobic fitness level of the divers.
Highlights
The risk factors of pulmonary edema induced by diving in healthy subjects are not well known
Environmental stressors experienced during Self-contained underwater breathing apparatus (SCUBA) diving such as water immersion, cold exposure, exercise intensity, hyperoxia, and decompression have been implicated in the pathogenesis [11]
At baseline, all divers had a number of ultrasound lung comets (ULC) lower than 5: 76 divers had no ULC, 22 divers had 1 ULC, 4 divers had 2 ULC, 3 divers had 3 ULC, and 1 diver had 4 ULC
Summary
The risk factors of pulmonary edema induced by diving in healthy subjects are not well known. The injury occurred more frequently in one sole diver among a group of divers performing the same dive profile, suggesting that some individual risk factors existed. Peacher et al [12] reported that among recreational divers, risk factors of cardio-respiratory disorders are more frequent than initially estimated (from 44 to 72%). Other risk factors such as female gender [13, 14], advanced age [4], consumption of fish oil [14] or anti-platelet agent [2], hypertension [15], and obesity [12] have been suggested
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