title: Sildenafil: Possible Prophylaxis against Swimming-induced Pulmonary Edema.
abstract: Swimming-induced pulmonary edema (SIPE) occurs during swimming and scuba diving, usually in cold water, in susceptible healthy individuals, especially military recruits and triathletes. We have previously demonstrated that pulmonary artery (PA) pressure and PA wedge pressure are higher during immersed exercise in SIPE-susceptible individuals versus controls, confirming that SIPE is a form of hemodynamic pulmonary edema. Oral sildenafil 50 mg 1 h before immersed exercise reduced PA pressure and PA wedge pressure, suggesting that sildenafil may prevent SIPE. We present a case of a 46-yr-old female ultratriathlete with a history of at least five SIPE episodes. During a study of an exercise submerged in 20°C water, physiological parameters before and after sildenafil 50 mg orally were as follows: O2 consumption 1.75, 1.76 L·min; HR 129, 135 bpm; arterial pressure 189/88 (mean 121.5), 172/85 (mean 114.3) mm Hg; mean PA pressure 35.3, 28.8 mm Hg; and PA wedge pressure 25.3, 19.7 mm Hg. She has had no recurrences during 20 subsequent triathlons while taking 50 mg sildenafil before each swim. This case supports sildenafil as an effective prophylactic agent against SIPE during competitive surface swimming.
authors.affiliation: Department of Anesthesiology, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC.
authors.forename: Stefanie D
authors.initials: SD
authors.lastname: Martina
authors.forename: John J
authors.initials: JJ
authors.lastname: Freiberger
authors.forename: Dionne F
authors.initials: DF
authors.lastname: Peacher
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Natoli
authors.forename: Eric A
authors.initials: EA
authors.lastname: Schinazi
authors.forename: Dawn N
authors.initials: DN
authors.lastname: Kernagis
authors.forename: Jennifer V F
authors.initials: JVF
authors.lastname: Potter
authors.forename: Claire E
authors.initials: CE
authors.lastname: Otteni
authors.forename: Richard E
authors.initials: RE
authors.lastname: Moon
mesh_terms: D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D011654:Pulmonary Edema / Q000503:physiopathology / Q000517:prevention & control*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D055502:Secondary Prevention; D000068677:Sildenafil Citrate / Q000627:therapeutic use*; D013550:Swimming / Q000502:physiology*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D000068677:Sildenafil Citrate