Le parcours de l’oxygène au cours de l’exercice incrémental

Characterizing Immersion Pulmonary Edema (IPE): A Comparative Study of Military and Recreational Divers

BACKGROUND

Immersion Pulmonary Edema (IPE) is a common and potentially serious diving accident that can have significant respiratory and cardiac consequences and, in some cases, be fatal. Our objective was to characterize cases of IPE among military trainees and recreational divers and to associate their occurrence with exposure and individual background factors such as age and comorbidity. We conducted a retrospective analysis on the medical records and diving parameters of all patients who were treated for IPE at the Hyperbaric Medicine Department of Sainte-Anne Military Hospital in Toulon, France, between January 2017 and August 2019. In total, 57 subjects were included in this study, with ages ranging from 20 to 62 years. These subjects were divided into two distinct groups based on exposure categories: (1) underwater/surface military training and (2) recreational scuba diving. The first group consisted of 14 individuals (25%) with a mean age of 26.5 ± 2.6 years; while, the second group comprised 43 individuals (75%) with a mean age of 51.2 ± 7.5 years. All divers under the age of 40 were military divers.

RESULTS

In 40% of cases, IPE occurred following intense physical exercise. However, this association was observed in only 26% of recreational divers, compared to 86% of military divers. Among civilian recreational divers, no cases of IPE were observed in subjects under the age of 40. The intensity of symptoms was similar between the two groups, but the duration of hospitalization was significantly longer for the recreational subjects.

CONCLUSION

It seems that the occurrence of IPE in young and healthy individuals requires their engagement in vigorous physical activity. Additionally, exposure to significant ventilatory constraints is a contributing factor, with the intensity of these conditions seemingly exclusive to military diving environments. In contrast, among civilian recreational divers, IPE tends to occur in subjects with an average age twice that of military divers. Moreover, these individuals exhibit more prominent comorbidity factors, and the average level of environmental stressors is comparatively lower.

[Cardiopulmonary exercise testing in the management of systemic sclerosis]

Cardiopulmonary complications are the leading cause of mortality in patients with systemic sclerosis (SSc) requiring an early identification. The complexity of the overlapping aetiologies of dyspnoea in SSc often requires a global and comprehensive approach. Through its integrative approach of ventilatory, metabolic, cardiovascular, skeletal muscular and gas exchange findings, cardiopulmonary exercise testing (CPET) has been known to identify and sort competing mechanisms of exercise limitation in scleroderma patients presenting with dyspnoea. CPET may be used to screen for pulmonary arterial hypertension, suspect interstitial lung disease and guide therapeutic strategies including exercise rehabilitation. This review focuses on the clinical value of CPET in the decision-making processes for a more personalised diagnostic approach to SSc-related complications.

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Zusammenfassung. Zusammenfassung: Respiratorische Insuffizienz aufgrund von pulmonaler oder kardialer Dekompensation ist ein medizinischer Notfall, der durch eine Gasaustauschstörung (Hypoxämie, isoliert oder in Verbindung mit Hyperkapnie) gekennzeichnet ist. Die Hauptursachen sind Lungenödem, Pneumonie, dekompensierte chronisch-obstruktive Lungenerkrankung, Lungenembolie und Asthma. Die unmittelbare Versorgung umfasst die Beurteilung der Schwere-Kriterien, wie Schock, verändertes Bewusstsein oder Atemnot mit schwerer Hypoxämie und/oder Hyperkapnie mit Azidose, die einen Transfer auf die Intensivstation erfordern. Die Behandlung umfasst Sauerstofftherapie und nicht-invasive Beatmung. Das Ansprechen auf die Behandlung in der ersten Stunde sollte unbedingt ausgewertet werden, und dessen Ausbleiben erfordert einen sofortigen Transfer auf die Intensivstation.