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

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.

Inter-limb changes in arterial function after intense cycling exercise.

We investigated whether muscle exercise, by inducing a subsequent local response, alters local and systemic arterial function differently. Eleven healthy volunteers (31±8 years) performed a 45-min cycling session at a heart rate corresponding to 10% above ventilatory threshold. Measurements were performed before and 45 min after exercise. Central and peripheral blood pressures were assessed by applanation tonometry and automatic sphygmomanometer, respectively. Brachial and popliteal arterial changes in diameter and blood flow were assessed using ultrasonography. The endothelium-dependent function was assessed simultaneously on brachial and popliteal arteries by flow-mediated dilation. Systolic blood pressure decreased significantly in both upper and lower limbs as well as centrally. Ankle-brachial index decreased significantly. Cross-sectional area and blood flow of popliteal and brachial arteries increased significantly. The increase in blood flow was higher in the brachial than in the popliteal artery, whereas diameter increase was of similar magnitude between the two arteries. When normalized with shear rate, brachial flow-mediated dilation was significantly greater, whereas popliteal flow-mediated dilation was similar post- vs. pre-exercise. After an acute bout of intense cycling, blood flow increase and endothelial function were greater in the non-exercised upper limb compared to the exercised lower limb, suggesting that anaerobic exercise blunts the enhancement of systemic endothelium-dependant vasodilation in active muscle beds.

Ultrasound lung comets induced by repeated breath-hold diving, a study in underwater fishermen.

Pulmonary edema has been reported in breath-hold divers during fish-catching diving activity. The present study was designed to detect possible increases in extravascular lung water (EVLW) in underwater fishermen after a competition. Thirty healthy subjects were studied. They participated in two different 5-h fish-catching diving competitions: one organized in the winter (10 subjects) and one organized in the autumn (20 subjects). A questionnaire was used to record underwater activity and note respiratory problems. An increase in EVLW was investigated from the detection of ultrasound lung comets (ULC) by chest ultrasonography. Complementary investigations included echocardiography and pulmonary function testing. An increase in EVLW was detected in three out of 30 underwater fishermen after the competition. No signs of cardiovascular dysfunction were found in the entire population and in divers with an increase in the ULC score. Two divers with raised ULC presented respiratory disorders such as cough or shortness of breath. Impairment in spirometric parameters was recorded in these subjects. An increase in EVLW could be observed after a fish-catching diving competition in three out of 30 underwater fishermen. In two subjects, it was related to respiratory disorders and impairment in pulmonary flow.