BACKGROUND: Swimming-induced pulmonary edema (SIPE), also called immersion pulmonary edema, is a form of exertional pulmonary edema associated with swimming and/or water immersion without aspiration. Most case reports on SIPE feature young, healthy patients who were scuba-diving, surface swimming, snorkeling, or breath-hold diving before experiencing symptoms of dyspnea, chest pain/tightness, cough, and hemoptysis. The incidence of SIPE is thought to be between 0.4–5%. Although symptoms typically resolve with oxygenation and ventilation, SIPE can be fatal, making recognition of SIPE crucial, especially for operational medical providers overseeing water training events and exercises.

CASE REPORT: A 28-yr-old healthy man began experiencing severe shortness of breath during early morning pool training. Oxygen saturation was in the low 80s and the patient was put on 15-L supplemental oxygen via nonrebreathing mask. Rales were present bilaterally on lung auscultation. He denied aspiration of water. Due to his persistent hypoxia, the patient was transported to an emergency department. He received a two-view chest X-ray, showing only bibasilar pulmonary opacities. He maintained 100% saturation once oxygen was removed and was able to be discharged to continue in the selection course.

DISCUSSION: Although SIPE may affect a small percentage of swimmers, military training in extreme conditions such as cold, lack of sleep, and profound exertion increases the risk for SIPE. Additionally, a patient who develops SIPE in the water is at risk for drowning. As SIPE may be fatal, military providers, especially those working with Special Operations, must be aware of how to diagnose and treat SIPE.

O’Keefe CL, Clemente Fuentes RW, Salinas E. Swimming-induced pulmonary edema in a member participating in a special tactics selection course. Aerosp Med Hum Perform. 2024; 95(12):937–939.