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. 2017 Oct 3;3(1):35.
doi: 10.1186/s40798-017-0104-1.

Observational study of potential risk factors of immersion pulmonary edema in healthy divers: exercise intensity is the main contributor

A Boussuges  1 , K Ayme  2 , G Chaumet  3 , E Albier  4 , M Borgnetta  4 , O Gavarry  5
Affiliations

Observational study of potential risk factors of immersion pulmonary edema in healthy divers: exercise intensity is the main contributor

A Boussuges et al. Sports Med Open. .

Abstract

Background: The 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.

Methods: This 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.

Results: One-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.

Conclusions: In 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.

Keywords: Chest ultrasonography; Diving medicine; Pulmonary edema; Ultrasound.

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Conflict of interest statement

Ethics approval and consent to participate

All experimental procedures were conducted in accordance with the declaration of Helsinki and were approved by the local ethical committee (Aix-Marseille University, n°2011-A01299-32). Each method and potential risk were explained to the participants in detail and they in turn gave written informed consent before the experiment.

Consent for publication

Consent to publish has been obtained from the participants to report individual data.

Competing interests

Alain Boussuges, Karine Ayme, Guillaume Chaumet, Eric Albier, Marc Borgnetta, and Olivier Gavarry declare that they have no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Two ultrasound lung comets (arrows) arising from the pleural line
Fig. 2
Fig. 2
Correlogram reporting the relationship between the variables. Positive relationship is in color blue and negative relationship in red color. Absence of relation is in white. Non-significant correlations are crossed (p > .05). In the upper part, an ellipse represents the orientation and the strength of the relation, the narrower the ellipse is, the higher the strength is. In the lower part, the rounded Spearman rho is indicated. Order of the variables is determined by hierarchical clustering with the “complete” agglomeration method. “sc.” is an abbreviation for scaled (centered and scaled). ULC ultrasound lung comet, SCUBA self-contained underwater breathing apparatus, Gas gas during decompression stop, O 2 oxygen, VAS visual analog scale, RPE rating of perceived exertion, Temp. temperature
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