PEP-device for Treatment of Swimming-induced Pulmonary Edema (SIPE)

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 or without oxygen in combination with diuretics, beta-agonist-inhalation or continuous positive airway pressure (CPAP). Evidence for optimal treatment strategy is lacking. Oxygen treatment might not be appropriate for patients with SIPE presenting without hypoxia. It is unknown if positive airway pressure accelerates recovery in SIPE.

This study intends to determine whether treatment with positive expiratory pressure (PEP) applied by PEP-device accelerates increase of oxygen saturation compared to spontaneous recovery in patients presenting with SIPE without hypoxia. 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 and oxygen saturation ≥92% are randomly assigned to 2 groups: (1) PEP-device for 20 minutes or (2) control group with spontaneous recovery without active treatment for 20 minutes. Assessment with outcome measures is taken 10 minutes after intervention/control. Primary endpoint: oxygen saturation (%) by pulse oxymetry.

• Change in absolute peripheral oxygen saturation (%) before and after treatment [Срок оценки: change before versus after 20 min treatment followed by 10 min rest]
• Recovery (yes/no) after treatment [Срок оценки: after 20 min treatment followed by 10 min rest]
• Interstitial syndrome assessed by lung ultrasound (yes/no) after treatment [Срок оценки: after 20 min treatment followed by 10 min rest]
• Absolute number of regions presenting B-lines on lung ultrasound after treatment [Срок оценки: 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 [Срок оценки: change before versus after 20 min treatment followed by 10 min rest]
• Change in patient reported outcome measures before and after treatment [Срок оценки: change before versus after 20 min treatment followed by 10 min rest]
• Admission to hospital (yes/no) [Срок оценки: 1 hour]
• Total treatment time [Срок оценки: 1 hour]