Immersion Pulmonary Edema Follow-up Study

Immersion Pulmonary Edema (also known as Swimming Induced Pulmonary Edema, SIPE)

SIPE is a condition where pulmonary edema occurs during swimming or diving. Its cause is believed to be related to an increase in pulmonary vascular pressures (pulmonary artery, capillary and vein) induced by immersion in water. Immersion in water normally induces a redistribution of 500-700 mL of blood from the legs into the heart and pulmonary vessels, causing a rise in intravascular pressure in those structures. If pulmonary vascular pressures are sufficiently high, pulmonary edema can ensue. Cardiac disease (such as hypertension, cardiomyopathy, valve disease, coronary artery disease) can predispose to SIPE. However the condition also occurs in perfectly healthy people, who are often extremely physically fit, for example triathletes and Navy diving recruits. Cold water and heavy exertion may play a role, as these factors tend to augment the normal immersion-related rise in pulmonary vascular pressures. The Duke Center for Hyperbaric Medicine & Environmental Physiology is actively studying this condition, in order to identify susceptible individuals and develop methods to prevent it.


  1. Wilmshurst PT, Nuri M, Crowther A, Webb-Peploe MM. Cold-induced pulmonary oedema in scuba divers and swimmers and subsequent development of hypertension. Lancet 1:62-5, 1989 (PMID: 2562880).
  2. Shupak A, Weiler-Ravell D, Adir Y, Daskalovic YI, Ramon Y. Kerem D. Pulmonary oedema induced by strenuous swimming: a field study. Respir Physiol 121:25-31, 2000 (PMID: 10854620).
  3. Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med 41:251-256, 2003 (PMID 12548277)

The Immersion Pulmonary Edema study is designed to learn why even the most physically fit divers can sometimes get pulmonary edema and what can be done to prevent it from occurring. The study got some extra help from international triathlete, Katherine Calder-Becker. “Kat” is a world champion athlete, but like many others with similar degrees of fitness, she has had Immersion Pulmonary edema (also known as Swimming Induced Pulmonary Edema or SIPE) five times. She traveled from her home in Montreal to Duke as a volunteer to participate  in our study. To see more pictures and read her report on what it was like to contribute to this important diving research project visit her website at:

If you have had Immersion Pulmonary Edema and would like more information about it, or if you would like to participate in the project (Duke pays travel expenses and gives a participation stipend), please contact Dr Moon or Dr. Freiberger at 919-684-6726 or email

Chris KeithImmersion Pulmonary Edema Follow-up Study