1. Pathophysiological and diagnostic implications of cardiac biomarkers and antidiuretic hormone release in distinguishing immersion pulmonary edema from decompression sickness
- Author
-
Pierre Naibo, Mathieu Coulange, Ian M. Jones, Emmanuel Fenouillet, Pierre Louge, Donato Vairo, Jean-Guillaume Steinberg, Jean Ruf, Olivier Le Pennetier, Marion Marlinge, Frederic Beneton, Yves Jammes, Pierre Michelet, Maxime Algoud, Emmanuel Gempp, Alain Boussuges, Régis Guieu, François Kerbaul, Lorene Dubourg, and Nathalie Kipson
- Subjects
diving ,Adult ,Male ,medicine.medical_specialty ,Heart Diseases ,Vasopressins ,Hemodynamics ,Observational Study ,Pulmonary Edema ,030204 cardiovascular system & hematology ,Snorkeling ,decompression sickness ,Gastroenterology ,Diagnosis, Differential ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Copeptin ,Internal medicine ,cardiac biomarkers ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Aged ,antidiuretic hormone ,Surrogate endpoint ,business.industry ,General Medicine ,Middle Aged ,Pulmonary edema ,medicine.disease ,Scuba diving ,Heart failure ,Anesthesia ,immersion pulmonary edema ,Female ,business ,Biomarkers ,Antidiuretic ,Research Article - Abstract
Immersion pulmonary edema (IPE) is a misdiagnosed environmental illness caused by water immersion, cold, and exertion. IPE occurs typically during SCUBA diving, snorkeling, and swimming. IPE is sometimes associated with myocardial injury and/or loss of consciousness in water, which may be fatal. IPE is thought to involve hemodynamic and cardiovascular disturbances, but its pathophysiology remains largely unclear, which makes IPE prevention difficult. This observational study aimed to document IPE pathogenesis and improve diagnostic reliability, including distinguishing in some conditions IPE from decompression sickness (DCS), another diving-related disorder.\ud \ud Thirty-one patients (19 IPE, 12 DCS) treated at the Hyperbaric Medicine Department (Ste-Anne hospital, Toulon, France; July 2013–June 2014) were recruited into the study. Ten healthy divers were recruited as controls. We tested: (i) copeptin, a surrogate marker for antidiuretic hormone and a stress marker; (ii) ischemia-modified albumin, an ischemia/hypoxia marker; (iii) brain-natriuretic peptide (BNP), a marker of heart failure, and (iv) ultrasensitive-cardiac troponin-I (cTnI), a marker of myocardial ischemia.\ud \ud We found that copeptin and cardiac biomarkers were higher in IPE versus DCS and controls: (i) copeptin: 68% of IPE patients had a high level versus 25% of DCS patients (P
- Published
- 2016