In swimming induced pulmonary edema (SIPE), there is a lack of knowledge regarding optimal treatment. The present study was designed to assess the benefit of continuous positive airway pressure (CPAP) compared to oxygen as a first line treatment of SIPE in the out-of-hospital environment.
Swimming induced pulmonary edema (SIPE) is an unusual condition affecting otherwise healthy swimmers. SIPE is characterized by acute onset of dyspnea and cough, excessive sputum and occasionally hemoptysis when swimming in open water. The condition usually resolves spontaneously within 48 hours, but may result in serious illness and require emergency care. Case reports describe acute treatment with oxygen alone or in combination with diuretics, beta-agonist-inhalation or continuous positive airway pressure (CPAP). Evidence for optimal treatment strategy is lacking. This study intends to determine whether oxygen alone or applied together with CPAP leads to improvement of oxygen saturation and recovery of patients. The aim is to treat patients on site without involving hospital care. We study a large cohort of approximately 12 000 swimmers during Vansbrosimningen, Sweden's biggest annual open water event with a yearly incidence of SIPE about 0,4%. Adult patients clinically diagnosed with SIPE are randomly assigned in 2 groups receiving treatment during 20 minutes: (1) oxygen 10l/min or (2) oxygen 10l/min and CPAP 7,5 cm H2O. Assessment with outcome measures is taken 10 minutes after treatment. Primary endpoint: oxygen saturation (%) by pulse oxymetry.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
90
Oxygen-driven CPAP (7,5 cmH2O): 20 min treatment followed by 10 min rest and assessment
Oxygen: 20 min treatment followed by 10 min rest and assessment
Center of Clinical Research Dalarna
Falun, Sweden
RECRUITINGAbsolute peripheral oxygen saturation (%) after treatment
Peripheral oxygen saturation % (continuous variable) measured by peripheral pulse oximetry
Time frame: after 20 min treatment followed by 10 min rest
Change in absolute peripheral oxygen saturation (%) before and after treatment
Change in peripheral oxygen saturation % (continuous variable) measured by pulse oximetry before and after treatment
Time frame: change before versus after 20 min treatment followed by 10 min rest
Recovery (yes/no) after treatment
Recovery, defined by "peripheral oxygen saturation \>95% after treatment" or no recovery, defined by "peripheral oxygen saturation ≤95% after treatment"
Time frame: after 20 min treatment followed by 10 min rest
Interstitial syndrome assessed by lung ultrasound (yes/no) after treatment
Four chest regions for both lungs are scanned by lung ultrasound; a positive region defined by the presence of three or more B-line artifacts. Bilateral or unilateral presence of two or more positive regions define positive interstitial syndrome.
Time frame: after 20 min treatment followed by 10 min rest
Absolute number of regions presenting B-lines on lung ultrasound after treatment
Four chest regions for both lungs are scanned by lung ultrasound; a positive region defined by the presence of three or more B-line artifacts. Assessment of the total number of positive regions.
Time frame: after 20 min treatment followed by 10 min rest
Change in absolute number of regions presenting B-lines on lung ultrasound before and after treatment
Four chest regions for both lungs are scanned by lung ultrasound; a positive region defined by the presence of three or more B-line artifacts. Assessment of the total number of positive regions. Change in absolute number of regions presenting B-lines on lung ultrasound before and after treatment
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Time frame: change before versus after 20 min treatment followed by 10 min rest
Change in patient reported outcome measures before and after treatment
Six different patient reported outcome measures assessed by numeric rating scale (NRS) 0-10: cough, sputum, air hunger, breathing effort, tightness in chest, anxiousness. The patients will assess symptoms prior to and after treatment.
Time frame: change before versus after 20 min treatment followed by 10 min rest
Admission to hospital (yes/no)
admission to hospital within or after a maximal treatment time of 40 minutes followed by 20 min rest.
Time frame: 2 hours
total treatment time
total treatment time until oxygen saturation ≥96% is reached.
Time frame: 2 hours
subgroup analysis
treatment outcome analysis in patients with different baseline oxygen saturation on admission
Time frame: 1 hour