The Oxygen Transport Triad in High-Altitude Pulmonary Edema: A Perspective from the High Andes

Abstract

Acute high-altitude illnesses are of great concern for physicians and people traveling to high altitude. Our recent article “Acute Mountain Sickness, High-Altitude Pulmonary Edema and High-Altitude Cerebral Edema, a View from the High Andes” was questioned by some sea-level high-altitude experts. As a result of this, we answer some observations and further explain our opinion on these diseases. High-Altitude Pulmonary Edema (HAPE) can be better understood through the Oxygen Transport Triad, which involves the pneumo-dynamic pump (ventilation), the hemo-dynamic pump (heart and circulation), and hemoglobin. The two pumps are the first physiologic response upon initial exposure to hypobaric hypoxia. Hemoglobin is the balancing energy-saving time-evolving equilibrating factor. The acid-base balance must be adequately interpreted using the high-altitude Van Slyke correction factors. Pulse-oximetry measurements during breath-holding at high altitude allow for the evaluation of high altitude diseases. The Tolerance to Hypoxia Formula shows that, paradoxically, the higher the altitude, the more tolerance to hypoxia. In order to survive, all organisms adapt physiologically and optimally to the high-altitude environment, and there cannot be any “loss of adaptation”. A favorable evolution in HAPE and pulmonary hypertension can result from the oxygen treatment along with other measures.

MFN2 deficiency promotes cardiac response to hypobaric hypoxia by reprogramming cardiomyocyte metabolism

“…The oxygen transport triad, which includes the pneumo-dynamic pump (ventilation), the hemo-dynamic pump (heart and circulation), and hemoglobin, plays an important role in this adaptation. 41 Initially, the body improves cardiac pump function by increasing heart rate and cardiac output. Additionally, the body increases alveolar ventilation through hyperventilation.…”

Morphological and functional findings in COVID-19 lung disease as compared to Pneumonia, ARDS, and High-Altitude Pulmonary Edema

“…Chest radiograph of patients with HAPE presents distinct patterns which can often be confused with cardiopulmonary diseases ( Nair et al, 2021 ). Unilateral or bilateral asymmetrical alveolar-interstitial opacities with relative sparing of the periphery and apices have been identified in some patients ( Zubieta-Calleja and Zubieta-DeUrioste, 2021a ). The opacities could be marginated, and the distribution patchy, with initial confluence in the perihilar region, and prominent horizontal fissure.…”

“…In most refractory and severe cases, extracorporeal carbon dioxide removal (ECCO2R) and extracorporeal membrane oxygenation (ECMO) could be used in order to reduce Plateau pressures and tidal volumes and prevent VILI while adequately oxygenating the lungs and improving oxygen supply to all tissues ( Battaglini et al, 2021 ). Other treatment options for improving gas exchange, include the use of erythropoietin in the treatment of severe COVID-19 pneumonia ( Ehrenreich et al, 2020 , Soliz et al, 2020 ) which can help improve the oxygen transport to tissues of the compromised oxygen transport triad (pneumo-dynamic pump, hemodynamic pump, and hemoglobin) ( Zubieta-Calleja et al, 2021 , Zubieta-Calleja and Zubieta-DeUrioste, 2021a ). Erythropoietin could also exert indirect effects not limited to the increase of red blood cells, hematocrit and hemoglobin but also to the protective effects of the hormone in different tissues like the heart, the vessels, and the brain ( Ehrenreich et al, 2020 , Hadadi et al, 2020 , Sahebnasagh et al, 2020 ).…”

“…A high incidence of different clinical presentations ( Lavinio et al, 2021 , Robba et al, 2021b ), as well as cardiac ( De Marzo et al, 2021 ), neurologic ( Battaglini et al, 2020b ), hepatic and renal injury ( Lopes-Pacheco et al, 2021 ), have been reported yielding the definition of Multiple Organ Dysfunction Syndrome (MODS)-CoV-2 ( Robba et al, 2020b ). COVID-19 pneumonia histopathological findings have been reported different from ( Batah and Fabro, 2021 ) or overlapped ( Xu et al, 2020 ) with Acute Interstitial Pneumonia (AIP), ARDS, or High Altitude Pulmonary Edema (HAPE) ( Pomara et al, 2020 , Zubieta-Calleja and Zubieta-DeUrioste, 2021a , Zubieta-Calleja and Zubieta-DeUrioste, 2021b ). These four diseases share similar clinical presentations, but also histopathological characteristics, and radiographic images.…”

Ayurvedic management through telemedicine of covid hypoxia non-dependent of oxygen support in a patient with chest CT score of 18/25- A case report

“…The organic systems of human beings and all other species tend to adapt to any environmental change and circumstance with an optimal period of time, and never tend towards regression which would inevitably lead to death- Prof. Dr. Gustavo Zubieta- Castillo Sr (1926–2015) [ 44 ]. Hence what the human body needs is-appropriate adaptogenic interventions to any disease including covid, which repurposed Ayurveda medicines provide effectively.…”