Swimming-Induced Pulmonary Edema in Endurance Athletes: Pathophysiology, Diagnosis, Acute Management, and Return to Sport – A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.77.75464Keywords
swimming-induced pulmonary edema; immersion pulmonary edema; open-water swimming; triathlon; lung ultrasound; pulmonary circulation; return to sportAbstract
Introduction and purpose. Swimming-induced pulmonary edema (SIPE) is an acute immersion-related condition occurring in otherwise healthy swimmers and triathletes. Rapid symptom progression in the water may increase drowning risk. This review summarizes current evidence on SIPE epidemiology, pathophysiology, diagnosis, treatment, recurrence and return to sport.
Materials and methods. A narrative review of PubMed/MEDLINE literature and relevant consensus statements available through August 2026 was conducted. Search concepts included SIPE, immersion pulmonary edema, open-water swimming, triathlon, pulmonary edema, lung ultrasound, risk factors, treatment and recurrence. Priority was given to systematic reviews, observational cohorts, diagnostic and hemodynamic studies, treatment studies and long-term follow-up data.
Results. SIPE is predominantly caused by hydrostatic pulmonary edema related to immersion-induced central blood-volume redistribution, exercise, cold-induced vasoconstriction and susceptibility to elevated pulmonary vascular pressures. Typical symptoms include acute dyspnea, cough, crackles, hypoxemia and occasionally hemoptysis during or shortly after swimming. Lung ultrasound may support rapid diagnosis. Management includes immediate exit from the water, oxygen when required and positive airway pressure in selected cases. Recurrence is clinically relevant, warranting assessment for cardiovascular risk factors or structural disease.
Conclusion. SIPE should be considered in athletes with unexplained respiratory distress during open-water swimming. Rapid recognition, supportive treatment and structured post-event evaluation are essential to reduce drowning risk and guide an individualized return to swimming.
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