Fluid Retention and Relative Hypoventilation in Acute Mountain Sickness

Hackett, Peter H.; Rennie, Drummond; Hofmeister, S. E.; Grover, Robert F.; Grover, Estelle B.; Reeves, John Τ.

doi:10.1159/000194501

Cited by 127 publications

(73 citation statements)

References 3 publications

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“…The latter study suggests, however, that hypoxic depression of ventilation may be associated with AMS. Indeed, direct or indirect measurements of ventilation performed at real or simulated altitude suggest hypoventilation of subjects with AMS compared with controls [5,6,8,10,31]. These observations could be explained by differences in hypoxic depression of ventilation or else by changes of the HVR occurring at high altitude.…”

Section: Discussionmentioning

confidence: 99%

Ventilatory and pulmonary vascular response to hypoxia and susceptibility to high altitude pulmonary oedema

Hohenhaus¹,

Paul²,

McCullough³

et al. 1995

Eur Respir J

144

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Reduced tolerance to high altitude may be associated with a low ventilatory and an increased pulmonary vascular response to hypoxia. We therefore, examined whether individuals susceptible to acute mountain sickness (AMS) or high altitude pulmonary oedema (HAPE) could be identified by noninvasive measurements of these parameters at low altitude. Ventilatory response to hypoxia (HVR) and hypercapnia (HCVR) at rest and during exercise, as well as hypoxic pulmonary vascular response (HPVR) at rest, were examined in 30 mountaineers whose susceptibility was known from previous identical exposures to high altitude. Isocapnic HVR expressed as difference in minute ventilation related to difference in arterial oxygen saturation (delta V'E/ delta Sa,O2) (L.min-1/%) was significantly lower in subjects susceptible to HAPE (mean +/- SEM 0.8 +/- 0.1; n = 10) compared to nonsusceptible controls (1.5 +/- 0.2; n = 10), but was not significantly different from subjects susceptible to AMS (1.2 +/- 0.2; n = 10). Hypercapnic ventilatory response was not significantly different between the three groups. Discrimination between groups could not be improved by measurements of HVR during exercise (50% maximum oxygen consumption (V'O2,max)), or by assessing ventilation and oxygen saturation during a 15 min steady-state exercise (35% V'O2,max) at fractional inspiratory oxygen (FI,O2) of 0.14. Pulmonary artery pressure (Ppa) estimated by Doppler measurements of tricuspid valve pressure at an FI,O2 of 0.21 and 0.12 (10 min) did not lead to a further discrimination between subjects susceptible to HAPE and AMS with the exception of three subjects susceptible to HAPE who showed an exaggerated HPVR. It is concluded that a low ventilatory response to hypoxia is associated with an increased risk for high altitude pulmonary oedema, whilst susceptibility to acute mountain sickness may be associated with a high or low ventilatory response to hypoxia. A reliable discrimination between subjects susceptible to high altitude pulmonary oedema and acute mountain sickness with a low ventilatory response to hypoxia is not possible by Doppler echocardiographic estimations of hypoxic pulmonary vascular response.

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Section: Discussionmentioning

confidence: 99%

Ventilatory and pulmonary vascular response to hypoxia and susceptibility to high altitude pulmonary oedema

Hohenhaus¹,

Paul²,

McCullough³

et al. 1995

Eur Respir J

144

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“…In terms of the respiratory mechanisms contributing to AMS, it has been long recognized that the ventilatory response is reduced in people susceptible to AMS (Hackett et al, 1982). Recently, in a group of people exposed to experimental hypoxia (FIO 2 = 80% SaO 2 ), the acute hypoxic ventilatory response at 5 min (HVR5min) was greater in individuals not susceptible to AMS compared to susceptible individuals (Nespoulet et al, 2012).…”

Section: Sleep Qualitymentioning

confidence: 99%

Acclimatization to chronic intermittent hypoxia in mine workers: a challenge to mountain medicine in Chile

Farías

Jiménez²,

Osorio³

et al. 2013

Biol. Res.

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In the past two decades, Chile has developed intense mining activity in the Andes mountain range, whose altitude is over 4,000 meters above sea level. It is estimated that a workforce population of over 55,000 is exposed to high altitude hypobaric hypoxia. The miners work under shift systems which vary from 4 to 20 days at the worksite followed by rest days at sea level, in a cycle repeated for several years. This Chronic Intermittent Hypoxia (CIH) constitutes an unusual condition for workers involving a series of changes at the physiological, cellular and molecular levels attempting to compensate for the decrease in the environmental partial pressure of oxygen (PO 2 ). The mine worker must become acclimatized to CIH, and consequently undergoes an acute acclimatization process when he reaches the worksite and an acute reverse process when he reaches sea level. We have observed that after a period of 3 to 8 years of CIH exposure workers acclimatize well, and evidence from our studies and those of others indicates that CIH induces acute and chronic multisystem adjustments which are eff ective in off setting the reduced availability of oxygen at high altitudes. The aims of this review are to summarize fi ndings of the physiological responses to CIH exposure, highlighting outstanding issues in the fi eld.

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“…Finally, there are a large number of studies of AMS reported in which both sexes were studied together without differentiating between them (e.g., Hackett et al, 1982;Dean et al, 1990;Anholm et al, 1979;Montgomery et al, 1989). The implicit assumption in the design of these studies was that AMS does not differ between men and women.…”

Section: Introductionmentioning

confidence: 99%

Women at Altitude: Effect of Menstrual-Cycle Phase on Acute Mountain Sickness During Deployment to High Altitude Terrain

Rock¹,

Muza²,

Fulco³

et al. 2001

PsycEXTRA Dataset

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m DISCLAIMERApproved for public release; distribution is unlimited.The views, opinions and/or findings in this report are those of the authors, and should not be construed as an official Department of the Army position, policy or decision, unless so designated by other official documentation.The investigators have adhered to the policies for protection of human subjects as prescribed in Army Regulation AR 70-25.Citations of commercial organizations and trade names in this report do not constitute an official Department of the Army endorsement or approval of the products or services of these organizations.REPORT Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources garnering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and The physiologic responses to the cyclic fluctuations in ovarian steroid hormones associated with the menstrual cycle in women are well known to affect certain disease states and could alter responses to environmental Stressors. Rapid deployment to high mountain terrain induces acute mountain sickness (AMS), which can be an important source of performance decrements and Disease and Non-Battle Injury loss of personnel in military units. To determine the effect of menstrual cycle phase on the occurrence of AMS, symptoms were assessed in 39 women aged 18 to 33 years with normal menstrual cycles who were expose«: to 4300 m altitude continuously on the summit of Pikes Peak, CO for 12 days or in a hypobaric chamber for 60 hours during the early follicular (follicular phase group) or luteal phase (luteal phase group) of their menstrual cycle. The clinical course of AMS in these women was similar to that reported previously in men. Overall, more than 60% of the women in this study experienced AMS during the first 24 hours of altitude exposure. There were no statistically significant differences between symptom scores of the follicular and luteal phase groups. However, the prevalence of AMS was slightly lower in the luteal phase compared to follicular phase volunteers. We conclude that effects of menstrual cycle phase are too small to be of practical significance for most women involved in military operations or civilian recreational pursuits at altitudes up to 4300 m.14. SUBJECT TERMS altitude illness, hypoxia, women, menstrual cycle, progesterone, estradiol, luteal, follicular Major funding for the project reported here came from DWHRP Extramural Grant #DAMD17-95-C-5110 entitled "Women at altitude: Effects of menstrual cycle phase and alpha-adrenergic blockade on high-altitude acclimatization." Additional funding was from D...

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Fluid Retention and Relative Hypoventilation in Acute Mountain Sickness

Cited by 127 publications

References 3 publications

Ventilatory and pulmonary vascular response to hypoxia and susceptibility to high altitude pulmonary oedema

Ventilatory and pulmonary vascular response to hypoxia and susceptibility to high altitude pulmonary oedema

Acclimatization to chronic intermittent hypoxia in mine workers: a challenge to mountain medicine in Chile

Women at Altitude: Effect of Menstrual-Cycle Phase on Acute Mountain Sickness During Deployment to High Altitude Terrain

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