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Thread: Pulmonary Oedema incident

  1. #31
    RBW Member lemon has a spectacular aura about lemon has a spectacular aura about lemon has a spectacular aura about lemon has a spectacular aura about lemon has a spectacular aura about lemon's Avatar
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by izze  View Original Post
    I suppose I should clarify that I mean that without pre-existing heart disease acute pulmonary oedema is unlikely unless a ischemic event (heart attack) took place. If you have congestive heart failure, immersion could cause the oedema.

    My opinion is that a normal electrocardiogram makes this less likely. CHF caused by hypertension tends to have some visible abnormalities on a ECG and if this was a cardiogenic oedema I would expect a pathological ECG for hours after the incident, even if you were feeling better.
    Izze makes some good points here. A normal chest x-ray and normal ecg certainly makes chronic CHF seem less likely (if they both were truly normal). I think that if you had a normal cardiac echo and stress i'd be highly inclined to suspect that what you experienced was IPE with your history of hypertension perhaps playing a role. This is all just long-distance conjecture on my part though and you should definitely listen to your treating physician.

    Again, best of luck and hoping for a clean bill of health on your evals.

  2. #32
    RBW Member JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes's Avatar
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by lemon  View Original Post
    Izze makes some good points here. A normal chest x-ray and normal ecg certainly makes chronic CHF seem less likely (if they both were truly normal). I think that if you had a normal cardiac echo and stress i'd be highly inclined to suspect that what you experienced was IPE with your history of hypertension perhaps playing a role. This is all just long-distance conjecture on my part though and you should definitely listen to your treating physician.

    Again, best of luck and hoping for a clean bill of health on your evals.
    Hi Lemon,

    Long distance conjecture - gotta love 'it :) And I do value it. Even if it is creating more of a blur than firm conclusions even that may be helpful. I will definitely listen to my treating physicians and hopefully with some firmer results (like definite cardio results) I'll start understanding what the primary diver(s) were in the episode and then hopefully be able to mitigate these.

    We'll get there in the end.

    Cheers,
    John

  3. #33
    Classic Kiss diver Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty's Avatar
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    Re: Pulmonary Oedema incident

    This does sound a lot like a pulmonary oedema issue, and I suspect the wheezing the day before was a much milder episode of the same. One big question is what caused it. Pulmonary oedema occurrs when the factors pushing fluid out of the pulmonary capillaries exceed the forces encouraging fluid back in. Therefore it can be multi-factorial, and a pre-existing cardiac condition or pulmonary hypertension (high blood pressure in the lung blood vessels) might make someone more susceptible which immersion could have then provoked. Other factors could also pre-dispose.
    In my anaesthetics and intensive care practice I see about one healthy patient a year with "negative pressure pulmonary oedema" this occurs on waking from anaesthesia if a patient obstructs their airway and makes a strong inspiratory effort against this - this produces a large pressure gradient between the pulmonary capillaries and the alveoli which drives fluid into the alveoli. They may also have recieved lots of fluid which may also make it easier to happen.
    Assuming your investigations show no heart problems, good exercise tolerance, and no pulmonary hypertension I would assume that this was some variant of immersion pulmonary oedema. This has even been described in fit healthy individuals who have ingested large amounts of fluid pre-immersion and gone swimming. (I presume you were not excessively over-hydrated?)
    I wonder if the rebreather is entirely irrelevant - you mention sucking very hard against the ADV which would increase pulmonary capillary to alveolus pressure gradient, it also has back-mounted counterlungs which you would expect to create a small negative pressure at the lungs too.
    It is possible that a combination of all these factors were enough to unmask some susceptibility to pulmonary oedema.
    I'm not specifically a diving doctor, but have some interests/relevant training. Personally unless some significant and reversible factor is identified which is then reversed I would personally not dive again, because a recurrence of this could easily be fatal as I'm sure you realise. I know this won't be what you want to hear, but would be my take on it. Hopefully a doctor with more diving experience will be able to advise you further and more specifically following your investigations.

  4. #34
    RBW Member JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes's Avatar
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    Re: Pulmonary Oedema incident

    Hi Sutty,

    Thanks for your post. I am taking this incident very seriously and am not considering diving again until the preconditions you mentioned are met - i.e. that we work out what likely caused it and fix those causes. Believe me, I've no desire of having another hour like that again never mind how selfish it would be to my family and fellow divers.

    But I am hopeful I can find the factors that caused it and mitigate against them.
    I do believe this was multi-factorial (I stress the word *belief* here - I certainly do not *know*).

    If and when I go back diving it will be with a much healthier lifestyle (working on that one already), no medication of any sorts, and shallow and OC. And we'll take it from there. If and when.

    Thanks,
    John

  5. #35
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    Re: Pulmonary Oedema incident

    [QUOTE=Sutty;374855] I see about one healthy patient a year with "negative pressure pulmonary oedema" this occurs on waking from anaesthesia if a patient obstructs their airway and makes a strong inspiratory effort against this - this produces a large pressure gradient between the pulmonary capillaries and the alveoli which drives fluid into the alveoli.

    you mention sucking very hard against the ADV which would increase pulmonary capillary to alveolus pressure gradient, it also has back-mounted counterlungs which you would expect to create a small negative pressure at the lungs too.

    Hey John, just found this one. As I was scanning this, I came up with the same thought. Negative Pressure Pulmonary Edema. You were on a cross-over from front mounted counterlungs??? When I took the revo cross over, I did experience wheezing underwater and difficulty breathing. Ultimately, I had not adjusted my loop volume enough based on the resistance I was used to. Never got into the anything you experienced!! I am totally fine with the unit now and anytime I feel like I have to "suck" on it, I add a little dil/O2 to it and it clears right up. I don't rely on my ADV to fire and if it does anyway, it signals to me that I need for loop volume, period!

    I am so glad you are able to write about it. I am also very glad you will be able to continue to dive!!!!

  6. #36
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by dreamdive  View Original Post
    Hey John, just found this one. As I was scanning this, I came up with the same thought. Negative Pressure Pulmonary Edema. You were on a cross-over from front mounted counterlungs??? When I took the revo cross over, I did experience wheezing underwater and difficulty breathing. Ultimately, I had not adjusted my loop volume enough based on the resistance I was used to. Never got into the anything you experienced!! I am totally fine with the unit now and anytime I feel like I have to "suck" on it, I add a little dil/O2 to it and it clears right up. I don't rely on my ADV to fire and if it does anyway, it signals to me that I need for loop volume, period!

    I am so glad you are able to write about it. I am also very glad you will be able to continue to dive!!!!
    Hi Dreamdive,
    Negative pressure pulmonary edema has been mentioned in a couple of places although I have been told that it has never been documented in the scientific/medical literature. Which would make me somewhat sceptical. However, I don't fully rule it out as possibly one factor in what may well be a multifactorial incident.

    In terms of being able to continue diving, whilst I'm optimistic about this, it's certainly not a done deal and I'm not signed off fit to dive at this point.

    Cheers,
    John

  7. #37
    Classic Kiss diver Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty's Avatar
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by JClynes  View Original Post
    Hi Dreamdive,
    Negative pressure pulmonary edema has been mentioned in a couple of places although I have been told that it has never been documented in the scientific/medical literature.
    John
    If you do a search for "negative pressure pulmonary oedema" or "negative pressure pulmonary edema"(american spelling) you will pull up a load of case reports. It's a well recognised phenomenon in anaesthesia, although I suspect there are also often other factors at work in many cases.

  8. #38
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by Sutty  View Original Post
    If you do a search for "negative pressure pulmonary oedema" or "negative pressure pulmonary edema"(american spelling) you will pull up a load of case reports. It's a well recognised phenomenon in anaesthesia, although I suspect there are also often other factors at work in many cases.
    Yeah, in anesthesia it can be from multiple brief instances of hypoxia (difficult intubation scenario). Young, healthy people seem more susceptible in my experience (did not look up stats for this one).

    Anyway, hope John will be OK.

  9. #39
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    Re: Pulmonary Oedema incident

    For the "pulmonary oedema" at the french navy military hospital inToulon (méditerane cost) half of the diving accident(military and civil) are pulmonary oedema and are ofen confuse with décompression accident on the boat.

    a pdf (sorry it's in french)
    http://mer.med.free.fr/CMPR%20BPL/file/OAP%20-CMPR.pdf

  10. #40
    RBW Member lemon has a spectacular aura about lemon has a spectacular aura about lemon has a spectacular aura about lemon has a spectacular aura about lemon has a spectacular aura about lemon's Avatar
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by JClynes  View Original Post
    In terms of being able to continue diving, whilst I'm optimistic about this, it's certainly not a done deal and I'm not signed off fit to dive at this point.

    Cheers,
    John
    from the DAN website regarding IPE:

    "Divers who have experienced IPE are concerned with the likelihood it will recur. Unfortunately, that likelihood is not known, so many physicians recommend that people with a history of IPE not return to diving. Still others recommend taking an antihypertensive medication before each dive. Before considering a return to diving after IPE, DAN recommends the diver consult with a doctor knowledgeable about the condition."

    still premature to say exactly what caused your incident but if it does turn out to be IPE it seems that there are some experts who will allow continued diving with anti-hypertensive meds. whether or not that would be appropriate for you would need to be determined by your doctors but at least it looks like there may be options.

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