High-Altitude Pulmonary Edema in Children With Underlying Cardiopulmonary Disorders and Pulmonary Hypertension Living at Altitude

Das, Bibhuti B.; Wolfe, Robert R.; Chan, Kak‐Chen; Larsen, Gary L.; Reeves, John Τ.; Ivy, D. Dunbar

doi:10.1001/archpedi.158.12.1170

Cited by 64 publications

(52 citation statements)

References 24 publications

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“…Despite overwhelming evidence against a primary inflammatory alteration of the alveolar-capillary barrier in HAPE, it is nevertheless conceivable that any concurrent process altering the permeability of the alveolar-capillary barrier will lower the pressure required for formation of oedema. Indeed, increased fluid accumulation during hypoxic exposure after priming by endotoxin or virus in animals [83,84] and the association of preceding respiratory viral infections with HAPE in children [85,86] support this concept. Thus, upper respiratory tract infections shortly before a sojourn in the mountains and vigorous exercise at altitudes between 2000 and 3000 m may explain in some cases why HAPE can develop at a modestly low altitude [87].…”

Section: Inflammationmentioning

confidence: 95%

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: Inflammationmentioning

confidence: 95%

Acute high-altitude sickness

2017

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“…Interestingly, there is also evidence to suggest that people with chronic pulmonary hypertension from high-altitude residences are also susceptible to HAPE development. DAS et al [165], for example, has described 10 children with chronic pulmonary hypertension (mean Ppa 38¡9 mmHg) secondary to living at moderate altitudes 1,610-3,050 m, who also developed HAPE with ascents to altitudes of 520-2,500 m above their residential altitude. Four out of the 10 patients had no underlying cardiopulmonary disease and were presumed to have pulmonary hypertension solely due to their high-altitude residence.…”

Section: Disorders Associated With Pulmonary Hypertensionmentioning

confidence: 99%

Travel to high altitude with pre-existing lung disease

Luks

Swenson²

2007

European Respiratory Journal

104

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The pathophysiology of high-altitude illnesses has been well studied in normal individuals, but little is known about the risks of high-altitude travel in patients with pre-existing lung disease. Although it would seem self-evident that any patient with lung disease might not do well at high altitude, the type and severity of disease will determine the likelihood of difficulty in a high-altitude environment. The present review examines whether these individuals are at risk of developing one of the main forms of acute or chronic high-altitude illness and whether the underlying lung disease itself will get worse at high elevations. Several groups of pulmonary disorders are considered, including obstructive, restrictive, vascular, control of ventilation, pleural and neuromuscular diseases. Attempts will be made to classify the risks faced by each of these groups at high altitude and to provide recommendations regarding evaluation prior to high-altitude travel, advice for or against taking such excursions, and effective prophylactic measures.

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“…Children residing at high altitude developing HAPE after returning from low to high altitude may have an inherited predisposition to the development of pulmonary hypertension, as suggested for lowland adults [5], since their Ppa rise is significantly greater than that of nonsusceptible controls when breathing a hypoxic gas mixture [3]. However, in addition to pulmonary artery hypertension, other mechanisms have been suggested, such as intercurrent viral infections leading to increased permeability of the blood-gas barrier [10,11] or a history of transient perinatal hypertension, possibly as consequence of a persistent defect of nitric oxide synthesis [12].…”

mentioning

confidence: 99%

Higher pulmonary artery pressure in children than in adults upon fast ascent to high altitude

Kriemler¹,

Jansen²,

Linka³

et al. 2008

European Respiratory Journal

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The response of pulmonary artery pressure to high altitude has not been studied in children. It is also not known whether the individual response is hereditary. Therefore, the response of pulmonary artery pressure to high altitude was measured in pre-pubertal children in comparison to that in their biological fathers.Echocardiography was performed at 450 m and over 3 days at 3,450 m. Systolic pulmonary artery pressure was estimated from the pressure gradient of tricuspid regurgitation.The increase in pulmonary artery pressure in children was greater than that in adults at day 1 of high altitude (15.5¡9.1 versus 7.9¡6.4 mmHg), but returned to adult levels on day 2. The increase in pulmonary artery pressure from low to high altitude of each child correlated with that in the father.Pre-pubertal children transiently develop greater pulmonary hypertension than their fathers when exposed to high altitude. The individual response of pulmonary pressure to high altitude seems to be at least partly hereditary.

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High-Altitude Pulmonary Edema in Children With Underlying Cardiopulmonary Disorders and Pulmonary Hypertension Living at Altitude

Abstract: Children living at altitude who develop HAPE should undergo screening for diagnosis of underlying cardiopulmonary abnormalities including pulmonary hypertension.

Cited by 64 publications

References 24 publications

Acute high-altitude sickness

Acute high-altitude sickness

Travel to high altitude with pre-existing lung disease

Higher pulmonary artery pressure in children than in adults upon fast ascent to high altitude

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