• Richard E Moon, Stefanie D Martina, Dionne F Peacher, Jennifer F Potter, Tracy E Wester, Anne D Cherry, Michael J Natoli, Claire E Otteni, Dawn N Kernagis, William D White, and John J Freiberger.
• From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.). richard.moon@duke.edu.
• Circulation. 2016 Mar 8; 133 (10): 988-96.

BackgroundSwimming-induced pulmonary edema (SIPE) occurs during swimming or scuba diving, often in young individuals with no predisposing conditions, and its pathophysiology is poorly understood. This study tested the hypothesis that pulmonary artery and pulmonary artery wedge pressures are higher in SIPE-susceptible individuals during submerged exercise than in the general population and are reduced by sildenafil.Methods And ResultsTen study subjects with a history of SIPE (mean age, 41.6 years) and 20 control subjects (mean age, 36.2 years) were instrumented with radial artery and pulmonary artery catheters and performed moderate cycle ergometer exercise for 6 to 7 minutes while submersed in 20°C water. SIPE-susceptible subjects repeated the exercise 150 minutes after oral administration of 50 mg sildenafil. Work rate and mean arterial pressure during exercise were similar in controls and SIPE-susceptible subjects. Average o2 and cardiac output in controls and SIPE-susceptible subjects were: o2 2.42 L·min(-1) versus 1.95 L·min(-1), P=0.2; and cardiac output 17.9 L·min(-1) versus 13.8 L·min(-1), P=0.01. Accounting for differences in cardiac output between groups, mean pulmonary artery pressure at cardiac output=13.8 L·min(-1) was 22.5 mm Hg in controls versus 34.0 mm Hg in SIPE-susceptible subjects (P=0.004), and the corresponding pulmonary artery wedge pressure was 11.0 mm Hg versus 18.8 mm Hg (P=0.028). After sildenafil, there were no statistically significant differences in mean pulmonary artery pressure or pulmonary artery wedge pressure between SIPE-susceptible subjects and controls.ConclusionsThese observations confirm that SIPE is a form of hemodynamic pulmonary edema. The reduction in pulmonary vascular pressures after sildenafil with no adverse effect on exercise hemodynamics suggests that it may be useful in SIPE prevention.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00815646.© 2016 American Heart Association, Inc.

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