Con: Hypoxic Cardiopulmonary Exercise Testing Identifies Subjects at Risk for Severe High Altitude Illnesses

BärtschPeter,

doi:10.1089/ham.2013.1145

Cited by 16 publications

(9 citation statements)

References 21 publications

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“…CANOUI-POITRINE et al [98] have developed and validated a model for identifying individuals at risk for severe altitude illness (severe AMS, HACE or HAPE), but the model requires an individual to undergo an exercise test while breathing a hypoxic gas mixture and, as a result, is not amenable to widespread, easy application. Furthermore, the value of such testing, which at present has not been validated by a prospective trial, was questioned in a recent pro [99] and con [100] debate.…”

Section: Prevention Of Acute Altitude Illnessmentioning

confidence: 99%

Acute high-altitude sickness

2017

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At any point 1-5 days following ascent to altitudes ⩾2500 m, individuals are at risk of developing one of three forms of acute altitude illness: acute mountain sickness, a syndrome of nonspecific symptoms including headache, lassitude, dizziness and nausea; high-altitude cerebral oedema, a potentially fatal illness characterised by ataxia, decreased consciousness and characteristic changes on magnetic resonance imaging; and high-altitude pulmonary oedema, a noncardiogenic form of pulmonary oedema resulting from excessive hypoxic pulmonary vasoconstriction which can be fatal if not recognised and treated promptly. This review provides detailed information about each of these important clinical entities. After reviewing the clinical features, epidemiology and current understanding of the pathophysiology of each disorder, we describe the current pharmacological and nonpharmacological approaches to the prevention and treatment of these diseases.

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Section: Prevention Of Acute Altitude Illnessmentioning

confidence: 99%

Acute high-altitude sickness

2017

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“…This may further decrease SaO 2 and cause hypoxia-induced illness. Exercise testing under hypobaric conditions in laboratory could identify subjects who will develop severe HAI upon ascent in some but not all studies [35,36]. Also, such method is apparently not suitable as a screening test to identify subjects susceptible for the less severe AMS in the general population [13].…”

Section: Predictive Value Of Exercise Testingmentioning

confidence: 99%

Association between physiological responses after exercise at low altitude and acute mountain sickness upon ascent is sex-dependent

et al. 2020

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Background Acute mountain sickness (AMS) is the mildest form of acute altitude illnesses, and consists of non-specific symptoms when unacclimatized persons ascend to elevation of ≥2500 m. Risk factors of AMS include: the altitude, individual susceptibility, ascending rate and degree of pre-acclimatization. In the current study, we examined whether physiological response at low altitude could predict the development of AMS. Methods A total of 111 healthy adult healthy volunteers participated in this trial; and 99 (67 men and 32 women) completed the entire study protocol. Subjects were asked to complete a 9-min exercise program using a mechanically braked bicycle ergometer at low altitude (500 m). Heart rate, blood pressure (BP) and pulse oxygen saturation (SpO2) were recorded prior to and during the last minute of exercise. The ascent from 500 m to 4100 m was completed in 2 days. AMS was defined as ≥3 points in a 4-item Lake Louise Score, with at least one point from headache wat 6–8 h after the ascent. Results Among the 99 assessable subjects, 47 (23 men and 24 women) developed AMS at 4100 m. In comparison to the subjects without AMS, those who developed AMS had lower proportion of men (48.9% vs. 84.6%, P < 0.001), height (168.4 ± 5.9 vs. 171.3 ± 6.1 cm, P = 0.019), weight (62.0 ± 10.0 vs. 66.7 ± 8.6 kg, P = 0.014) and proportion of smokers (23.4% vs. 51.9%, P = 0.004). Multivariate regression analysis revealed the following independent risks for AMS: female sex (odds ratio (OR) =6.32, P < 0.001), SpO2 change upon exercise at low altitude (OR = 0.63, P = 0.002) and systolic BP change after the ascent (OR = 0.96, P = 0.029). Women had larger reduction in SpO2 after the ascent, higher AMS percentage and absolute AMS score. Larger reduction of SpO2 after exercise was associated with both AMS incidence (P = 0.001) and AMS score (P < 0.001) in men but not in women. Conclusions Larger SpO2 reduction after exercise at low altitude was an independent risk for AMS upon ascent. Such an association was more robust in men than in women. Trial registration Chinese Clinical Trial Registration, ChiCTR1900025728. Registered 6 September 2019.

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“…Although the larger subject numbers were driven by a few large studies, overall there is evidence of an association between lower SpO 2 and/or HVR with AMS susceptibility (13). However, given the complexity of conducting these tests and the large overlap of these measured variables between AMS-susceptible and AMS-resistant individuals, adoption of these AMS susceptibility tests on a large scale in a healthy military population would likely not be an effective approach to reducing risk of AMS or severe high-altitude illnesses (3).…”

Section: Physiological Prediction and Detection Of Amsmentioning

confidence: 99%

Wearable physiological sensors and real-time algorithms for detection of acute mountain sickness

Muza

2018

Journal of Applied Physiology

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This is a minireview of potential wearable physiological sensors and algorithms (process and equations) for detection of acute mountain sickness (AMS). Given the emerging status of this effort, the focus of the review is on the current clinical assessment of AMS, known risk factors (environmental, demographic, and physiological), and current understanding of AMS pathophysiology. Studies that have examined a range of physiological variables to develop AMS prediction and/or detection algorithms are reviewed to provide insight and potential technological roadmaps for future development of real-time physiological sensors and algorithms to detect AMS. Given the lack of signs and nonspecific symptoms associated with AMS, development of wearable physiological sensors and embedded algorithms to predict in the near term or detect established AMS will be challenging. Prior work using [Formula: see text], HR, or HRv has not provided the sensitivity and specificity for useful application to predict or detect AMS. Rather than using spot checks as most prior studies have, wearable systems that continuously measure SpO and HR are commercially available. Employing other statistical modeling approaches such as general linear and logistic mixed models or time series analysis to these continuously measured variables is the most promising approach for developing algorithms that are sensitive and specific for physiological prediction or detection of AMS.

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Con: Hypoxic Cardiopulmonary Exercise Testing Identifies Subjects at Risk for Severe High Altitude Illnesses

Cited by 16 publications

References 21 publications

Acute high-altitude sickness

Acute high-altitude sickness

Association between physiological responses after exercise at low altitude and acute mountain sickness upon ascent is sex-dependent

Wearable physiological sensors and real-time algorithms for detection of acute mountain sickness

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