CPAP, PEP device useful for managing swimming-induced pulmonary oedema

Noninvasive positive pressure ventilation (NPPV) with continuous positive airway pressure (CPAP) by facial mask or a positive expiratory pressure (PEP) device is safe and feasible for use as prehospital treatment for swimming-induced pulmonary oedema (SIPE), as reported in a study.

The study used data from a prospective observational study conducted at Vansbrosimningen, Sweden’s largest open water swimming event, in 2017–2019. A total of 119 swimmers diagnosed with SIPE and with peripheral oxygen saturation (SpO₂) ≤95 percent and/or persistent respiratory symptoms were included in the analysis.

Of the participants, 94 received CPAP, 24 the PEP device; only one participant required tracheal intubation. NPPV was administered on-site.

The majority of the participants (108, 91 percent) were discharged after NPPV for median 10-20 minutes, while 11 (9 percent) required hospital transfer. Discharge criteria were SpO₂ >95 percent and clinical recovery.

Overall, NPPV resulted in an increase in SpO₂, from a median of 91 percent before treatment to 97 percent post-treatment (p<0.0001). A parallel improvement in six patient-reported respiratory symptoms was seen (median numerical rating scales, from 1–7 to 0–1; p<0.0001).

There was no significant decline in auscultation of crackles (93 percent vs 87 percent; p=0.508) or pulmonary oedema on lung ultrasound (100 percent vs 97 percent; p=0.500) during NPPV treatment.

The findings indicate that most patients who present with SIPE can be safely discharged onsite following prehospital treatment with CPAP or PEP device, with improvements after treatment reflected by increased peripheral oxygen saturation and alleviation of patient-reported respiratory symptoms.