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coronary arteries. The results of this
further testing should dictate return
to diving. A person who experiences
recurrent episodes of IPE should
probably refrain from diving again in
the future.
What do we not understand about
IPE — in what ways is it still a
mystery?
Bove:
The mechanisms of IPE
are not well understood. The
phenomenon of negative-pressure
pulmonary edema is well known in
anesthesia and likely contributes to
IPE in divers. The development of
pulmonary edema in swimmers is
better understood and has a model
in the well-known pulmonary edema
problem found in highly motivated
racehorses. However, there are still
a number of divers and swimmers
who get IPE who don’t have a good
explanation for why it occurred.
Ebersole:
Despite the best efforts
of many investigators, the medical
community does not know
much about IPE. Until we better
understand the mechanism of the
disorder and who is predisposed
to it, it is difficult to make
recommendations to divers as to
how to avoid it or when to return to
diving after an episode.
Witucki:
The cause! We do not
know what causes IPE nor can we
currently predict which people
are at increased risk of developing
this condition. We know how to
identify and treat IPE. We know
the disease involves fluid leaking
out of pulmonary capillaries and
into the alveoli. What we do not
know is why it occurs. It is hoped
the research that is currently under
way will answer this question or at
least begin to lead us in the right
direction.
AD
MEET the experts
Alfred Bove, M.D., Ph.D.,
is professor emeritus of medicine at the Temple
University School of Medicine in Philadelphia, Pa. He is board certified in cardiology, internal
medicine, and undersea and hyperbaric medicine. Dr. Bove is a National Association of
Underwater Instructors (NAUI) lifetime scuba instructor, course director for Temple University
Underwater Medicine and author of the textbook Diving Medicine.
Douglas Ebersole, M.D.,
is an invasive and interventional cardiologist at Watson
Clinic and director of the cardiac catheterization laboratories at Lakeland Regional Medical
Center in Lakeland, Fla. He is a cave and technical diver, a Scuba Schools International (SSI)
instructor and an International Association of Nitrox and Technical Divers (IANTD) and Technical
Diving International (TDI) rebreather and trimix instructor.
Pete Witucki, M.D.,
is a faculty member in the Department of Emergency Medicine
at University of California San Diego Medical Center. He is board certified in emergency medi-
cine as well as undersea and hyperbaric medicine. He served as a Diving Medical Officer (DMO)
in the U.S. Navy for four years and continues to serve as a DMO in the U.S. Navy Reserves.
Current Research
Dr. Richard Moon of the Duke Center for Hyperbaric Medicine and Environmental Physiology, in
collaboration with DAN, is currently conducting research on IPE. The goal of the study is to iden-
tify susceptible individuals and develop methods to prevent the condition. DNA samples from
participants who have experienced IPE will be compared with samples from those who have
not, and the effects of cold-water immersion on blood pressure, cardiac output and pulmonary
artery pressures will be compared between the two groups. Volunteers with a history of IPE are
still needed for the study. For more information, contact IPEdivestudy@notes.duke.edu
.
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