A SIPE Incident Hits the News Again

Undercurrent has often warned of the dangers of Submersion-Induced Pulmonary Edema (SIPE), most recently in September 2023. Still, the threat of SIPE or its recognition hasn't deeply penetrated the minds of divers or some in the dive community.

In February, an inquest in the UK looked into the death of Robert Bolton while diving in Indonesia.

Former Royal Navy officer Robert Bolton and his wife were diving in Komodo National Park. Bolton ascended to the surface, where he suffered seizures and was rushed to hospital by speedboat. Winchester Coroner's Court in the UK heard Mr. Bolton suffered an immersion pulmonary edema, a swimming-induced condition where fluid leaks from blood vessels into the lung.

In a written statement, his wife said, "He had panic in his eyes, he was scared, breathing heavily and holding his chest." When she came up, she was picked up by another speedboat and taken to where her husband was being worked on. Though he was fit and strong, he never regained consciousness and passed away at the Mount Elizabeth Hospital on September 23, 2023. In a statement for the inquest, Dr. Peter Wilmshurst, an expert in edemas and an experienced diver, said the risk of an edema was 13 times higher in those over 60.

What are the symptoms of SIPE?

It begins when fluid from the arms and legs (which tend to retain water under normal gravity conditions) collects in the lungs of the immersed person rather than returning to the bladder as normal. The victim finds it harder and harder to breathe, culminating in asphyxiation. In effect, victims drown in their own body fluids. The only remedy is the total and timely removal of the person from the water. (https://tinyurl.com/4dk3kty6)

What are the predisposing factors and preconditions?

Several predisposing factors and preconditions can make a scuba diver more susceptible to Submersion- Induced Pulmonary Edema (SIPE).

1. Cardiovascular Conditions

• • Hypertension (high blood pressure)
• • Left ventricular dysfunction
• • Valve diseases (e.g., mitral valve regurgitation)

2. Pre-existing Respiratory Conditions

• • Asthma or reactive airway disease
• • Pulmonary hypertension.

3. Fitness and Training

• • Overexertion during a dive: Excessive physical effort can raise blood pressure and strain the heart and lungs.
• • Lack of cardiovascular fitness: Can impair the body's ability to handle changes in circulation during immersion.

4. Cold Water Exposure

• • Cold-induced vasoconstriction increases central blood volume and pulmonary artery pressure, making IPE more likely, especially in colder waters.

5. Diving Conditions

• • Tight wetsuits or drysuits: Restrict chest expansion and increase intrathoracic pressure.
• • Negative buoyancy at depth: Can require excessive effort to breathe, adding strain on the lungs and heart.

6. Age and Gender

• • Older age: Cardiovascular and respiratory conditions become more common with age, raising susceptibility.
• • Female divers: Some studies suggest women might be at higher risk, potentially due to differences in lung or cardiac physiology.

7. Use of Medications

• • Diuretics: May alter the fluid balance and exacerbate fluid accumulation in the lungs.
• • Beta-blockers: Can impair the cardiovascular response to exertion.

8. Psychological Factors

• • Stress or anxiety: May lead to hyperventilation or overexertion, contributing to changes in pulmonary pressures.

9. Excessive Pre-Dive Hydration

• • Overhydration increases blood volume, which may elevate central and pulmonary pressures.

10. Genetic Predisposition

• • Some individuals may have underlying conditions or anatomical differences predisposing them to fluid imbalance or lung capillary leakage.

If a diver has any of these preconditions, it's essential to undergo a thorough medical evaluation before diving. And while diving and afterward, divers should monitor themselves for early signs of SIPE (e.g., difficulty breathing, coughing, or chest discomfort during or after a dive).

Had an SIPE Incident? Give Up Diving!

Diving medical experts from around the world have issued a joint position statement on the subject (SIPE) the condition that has come to concern scuba divers as well as snorkelers and other surface swimmers. The specialist group strongly advises divers with previous suspected or confirmed SIPE to think hard before pressing on with further scuba diving.