reference #35 of your second article has F. Modave as a coauthor (Francois on the forum).

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salmon - not because I'm a fish

Yeah,the folks here on ST were all over this back in the day.
Swimming Induced Pulmonary Edema (SIPE) - Slowtwitch.com
Here is Kat Calder-Beckers page with a lot of links to various studies back then.She is a co-author of the same study #35
Endurance Triathletes - Swimming Induced Pulmonary Edema (SIPE) - Immersion Pulmonary Edema (IPE)
I ended up in Noosa Hospital with P.E in the second day of Ultraman Oz in 2018.It was thought that ingesting far too much salt water during the swim resulted in a string of issues that would lead to a pretty intense few hours in the Emercency Ward.

The studies on SIPE were a great leap in understanding issues during cold water swims. It basically debunked the ‘then common’ suggested cause of issues: that being the wet suit was too tight.

However, there have been many sudden cardiac deaths in the swim over the past 10+ years not due to SIPE, and we know very little about the causes. What we do know is that sudden cardiac death has occurred in both calm and rough water conditions, both wetsuit and none wetsuit swims, the majority have been males over 40 (with an increase in likelihood for males over 60) who were not inexperienced swimmers. Some cardiac events have occurred within a very short time after the start of the swim. With the information available, these weren’t drownings either, this suggests that there wasn’t panic, swallowing water, etc., just cardiac arrest induced by a currently unknown cause.

So far the only tangible suggestion to minimize the possibility of occurrence (other than Sidfidal in the SIPE study) is to do a warm up swim before the start.

I had a suspected case of SIPE at IMAZ 2021. The one thing besides the sidenafil and warm-up is I've been instructed to avoid excessive salt intake pre-race, which I habitually did before races in the past.

ETA … was also told to consider only doing races where the water will not be cold.

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Dimond Bikes Superfan

I did read where some original theories were ingestion of water (salt or fresh), but because SIPE is also well-known in the diving community (not a lot of water ingestion while diving), they've started to change the theory of cold and/or exercise stress as a driving cause.

I'm interested in your 2018 event. Did you feel unprepared for the event (can't imagine that being the case but had to ask)? What, if anything, was the treatment? How did they diagnose it as SIPE? Have you ever had other events after that?

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Not a coach. Not a FOP Tri/swimmer/biker/runner. Barely a MOP AGer.
But I'm learning and making progress.

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I was fit enough to be a participant and do the swim and two bike days comfortably, with the expectation that the run day was going to be very "social". My training had been stalled for months due to some family health issues but I did do a four week surf swim/bike block before the race to make sure the two tough days were going to be doable.

The swim was fine (3:08) and I just went through the motions but I have a bad habit of drinking water while I am swimming,which is great in places like Penticton where the lakes are fresh water but in the ocean,it is a different story.I knew I was going to have a shitty day (literally) at around 9k when my gut started to turn and I knew I had ingested too much salt water. A very long T1 sitting on the toilet followed by a lot of pit-stops on the bike visiting public toilets around the course while wondering why I couldn't ride properly lead to a very slow day.

I had a nurse on my crew who was totally new to Ultra stuff and she was really concerned about me that night as she kept saying that she could hear my lungs rattling from across the room and wondered if I usually coughed that much.I felt unusually tired but figured it had just been a tough day. She now regrets not stepping in and forcing me to go to hospital that night but she didn't know me and was the girlfriend of my crew chief and as I said was new to all this tri-stuff.

Stupid guys like me tend to brush all that shit aside and say "I'm fine" (It was my 17th Ultra-tri) But it came back to haunt me.I woke up bloated and sick on day two but started the bike anyway. I lasted about 40mins before I was found on the side of the road in the dark by a race staffer and they called my crew. The race medico's were there and as soon as my crew arrived Sue,the nurse said "I suspect he has Pumlonary Edema and he is going to hospital right now". They drove me to hospital and she was right. By that stage I was so totally bloated from retaining all the fluids I have ingested over the previous few hours and you can see it in the photo,especially around my neck and gut. After getting images done to confirm PE the ER doctor(also a triathlete) stated a course of med's to decrease the bloating,deal with my blood pressure and began Positive Pressure Ventilation and said, "right now,I am trying to stop you from having a heart attack".

I was on the machine for a few hours until I started to stabilize and my numbers approached normal. During that time I contacted Kat Calder-Becker (one of the contributors to that ST article) as I know her personally from the Ultraman family and we tried to figure out if it was indeed SIPE as they knew it. Warm water swim,no chest constriction,no panic or hyperventilation at all. Not their classic case of SIPE.It became apparent that it was the salt water excess that most likely caused the P.E .

I was released in the care of my crew after about 7 hrs and was told by the ER Doc, "I wouldn't at all be surprised to see you back here in a day or two" and not to be so stubborn in listening to what my body is telling me. She came to the race transition later that night to check up on me and speak to the race director and see what the race was all about.It took days for the bloating to go down but I recovered well and have had no other issues at all since. (I did get HAPE in Bolivia once,but that is a different story)

Thanks for the info and I’m glad your good now.

You true ultra folks are amazing and I’m in awe of all of you.

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Not a coach. Not a FOP Tri/swimmer/biker/runner. Barely a MOP AGer.
But I'm learning and making progress.

A reply to all here, and very interesting topic. I've a couple questions related to SIPE (and may have already discussed before);

Has SIPE been observed or documented in persons doing regular training-type swims in open water? That is, not during a race event that adds an extra element of stress.

Is SIPE only occurring in wetsuit wearers? Any observations of SIPE in large non-wetsuit events such as IMH?