Отек легких при занятиях плаванием

За последние 30 лет множественные отчеты и исследования описывают синдром острой одышки с выделением кровяной или розовой пенистой мокроты после сильных физических нагрузок, таких как боевая подготовка, триатлон и плавание на большие дистанции [134-138]. В данных рекомендациях мы сфокусировались на аспектах, связанных с плаванием на поверхности, не касаясь ныряния на глубину. Острый отек легких вследствие занятия плаванием, вероятнее всего, может быть вызван увеличением сердечного выброса, перераспределением циркулирующей крови с перегрузкой малого круга в результате периферической вазоконстрикции и, возможно, гипергидратацией. Несмотря на то, что частота возникновения данного синдрома, согласно данным различных исследований, сильно варьирует, зарегистрировано лишь небольшое количество описаний тяжелых случаев или неблагоприятных исходов. Исследования показывают преходящие изменения функционального состояния дыхательной системы, регистрируемые в течение не более 1 недели без каких-либо нарушений со стороны функции сердца [135].

Рекомендация: Пациентам с проявлением симптомов, соответствующих отеку легкого, после занятия плаванием следует отменить значительные физические нагрузки до полного восстановления и проконсультироваться на предмет возможных преходящих изменений функциональных показателей дыхания. Пациенты с подобным синдромом обычно восстанавливаются самостоятельно без лечения, и, при отсутствии симптомов тяжелого дыхательного расстройства, проведение эвакуации не требуется. (Уровень рекомендации – 2С)

ЗАКЛЮЧЕНИЯ

Утопление – это состояние, которое может как протекать без последствий, так и давать осложнения, вплоть до тяжелых, а также может приводить к смерти. Как и в отношении других патологических состояний, случающихся в условиях дикой природы, лучший способ лечения утоплений – это профилактика. Она включает в себя комплексный подход, предусматривающий обучение плаванию, должное наблюдение, использование индивидуальных спасательных жилетов или других персональных спасательных плавсредств, знание состояния воды и погодных условий и исключение приема алкоголя и сильнодействующих веществ. Когда объем профилактики оказался недостаточным, или ситуация привела к развитию утопления, наиболее важным аспектом лечения является предотвращение церебральной гипоксии путем доставки кислорода к головному мозгу любым доступным способом.

КОНФЛИКТ ИНТЕРЕСОВ

Авторы хотели бы сообщить следующее: A.S. и J.S. являются директорами организации "Спасатели без границ" (Lifeguards Without Borders); S.H. является медицинским директором Landmark Learning, медицинским директором Starfish Aquatics Institute, медицинским директором NC State Parks, владельцем Hawk Ventures, медицинским директором Burke County EMS и исполнительным редактором Wilderness Medicine; T.C. является членом совета Общества экстремальной медицины (Wilderness Medical Society, WMS), И является председателем Комитета по практическим руководствам WMS. A.A. и P.A. не имеют конфликтов интересов для публикации.

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