To compare the incomparable: COVID-19 pneumonia and high-altitude disease

Strapazzon, Giacomo; Hilty, Matthias P.; Bouzat, Pierre; Pratali, Lorenza; Brugger, Hermann; Rauch, Simon

doi:10.1183/13993003.01362-2020

Cited by 18 publications

(18 citation statements)

References 11 publications

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“…However, there is now a consensus that fundamentally different pathophysiological mechanisms underlie the COVID‐19 induced ARDS and HAPE and that both require different therapeutic approaches (Archer et al., 2020; Brugger et al., 2020; Luks et al., 2020; Luks & Swenson, 2020; Strapazzon et al., 2020).…”

Section: Do High‐altitude Illnesses and Sars‐cov‐2 Induced Pathologiementioning

confidence: 99%

“…coronavirus, hypoxemia, hypoxia, immunity, mitochondria, pandemic Strapazzon et al, 2020). HAPE is non-cardiogenic pulmonary edema caused by exaggerated uneven hypoxic pulmonary vasoconstriction (HPV) and abnormally high mean pulmonary artery (PA) pressure leading to a non-inflammatory, alveolar-capillary leak and edema formation (Bartsch & Swenson, 2013;Maggiorini et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

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Altitude and COVID‐19: Friend or foe? A narrative review

et al. 2020

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Recent reports suggest that high‐altitude residence may be beneficial in the novel coronavirus disease (COVID‐19) implicating that traveling to high places or using hypoxic conditioning thus could be favorable as well. Physiological high‐altitude characteristics and symptoms of altitude illnesses furthermore seem similar to several pathologies associated with COVID‐19. As a consequence, high altitude and hypoxia research and related clinical practices are discussed for potential applications in COVID‐19 prevention and treatment. We summarize the currently available evidence on the relationship between altitude/hypoxia conditions and COVID‐19 epidemiology and pathophysiology. The potential for treatment strategies used for altitude illnesses is evaluated. Symptomatic overlaps in the pathophysiology of COVID‐19 induced ARDS and high altitude illnesses (i.e., hypoxemia, dyspnea…) have been reported but are also common to other pathologies (i.e., heart failure, pulmonary embolism, COPD…). Most treatments of altitude illnesses have limited value and may even be detrimental in COVID‐19. Some may be efficient, potentially the corticosteroid dexamethasone. Physiological adaptations to altitude/hypoxia can exert diverse effects, depending on the constitution of the target individual and the hypoxic dose. In healthy individuals, they may optimize oxygen supply and increase mitochondrial, antioxidant, and immune system function. It is highly debated if these physiological responses to hypoxia overlap in many instances with SARS‐CoV‐2 infection and may exert preventive effects under very specific conditions. The temporal overlap of SARS‐CoV‐2 infection and exposure to altitude/hypoxia may be detrimental. No evidence‐based knowledge is presently available on whether and how altitude/hypoxia may prevent, treat or aggravate COVID‐19. The reported lower incidence and mortality of COVID‐19 in high‐altitude places remain to be confirmed. High‐altitude illnesses and COVID‐19 pathologies exhibit clear pathophysiological differences. While potentially effective as a prophylactic measure, altitude/hypoxia is likely associated with elevated risks for patients with COVID‐19. Altogether, the different points discussed in this review are of possibly some relevance for individuals who aim to reach high‐altitude areas. However, due to the ever‐changing state of understanding of COVID‐19, all points discussed in this review may be out of date at the time of its publication.

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Section: Do High‐altitude Illnesses and Sars‐cov‐2 Induced Pathologiementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Altitude and COVID‐19: Friend or foe? A narrative review

et al. 2020

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“…HAPE is related to an excessive hypoxia-mediated increase in pulmonary vascular resistance or hypoxic pulmonary vasoconstriction increasing microvascular pressure and leading to a substantial increase in pulmonary artery pressure with overperfusion of some regions of the lung, elevated pulmonary capillary hydrostatic pressure, and leakage of fluid into the alveolar space ( Swenson and Bartsch, 2012 ). Consequently, HAPE is a life-threatening condition that is favorably influenced (often reversed) by oxygen therapy, exposure to hyperbaric environment (using portable hyperbaric chambers), or descent/evacuation to lower altitude and, finally, very unusually needs intensive care ( Swenson and Bartsch, 2012 ; Strapazzon et al, 2020 ). Since hypoxic vasoconstriction is the fundamental pathogenesis mechanism in HAPE, increasing the alveolar PO 2 decreases pulmonary artery pressure, allowing the resolution of alveolar and interstitial edema and full recovery within hours to a few days of exposure.…”

Section: Lessons From High Altitude and Aviation Physiology: Are The mentioning

confidence: 99%

The Fundamentals of Respiratory Physiology to Manage the COVID-19 Pandemic: An Overview

et al. 2021

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The growing coronavirus disease (COVID-19) crisis has stressed worldwide healthcare systems probably as never before, requiring a tremendous increase of the capacity of intensive care units to handle the sharp rise of patients in critical situation. Since the dominant respiratory feature of COVID-19 is worsening arterial hypoxemia, eventually leading to acute respiratory distress syndrome (ARDS) promptly needing mechanical ventilation, a systematic recourse to intubation of every hypoxemic patient may be difficult to sustain in such peculiar context and may not be deemed appropriate for all patients. Then, it is essential that caregivers have a solid knowledge of physiological principles to properly interpret arterial oxygenation, to intubate at the satisfactory moment, to adequately manage mechanical ventilation, and, finally, to initiate ventilator weaning, as safely and as expeditiously as possible, in order to make it available for the next patient. Through the expected mechanisms of COVID-19-induced hypoxemia, as well as the notion of silent hypoxemia often evoked in COVID-19 lung injury and its potential parallelism with high altitude pulmonary edema, from the description of hemoglobin oxygen affinity in patients with severe COVID-19 to the interest of the prone positioning in order to treat severe ARDS patients, this review aims to help caregivers from any specialty to handle respiratory support following recent knowledge in the pathophysiology of respiratory SARS-CoV-2 infection.

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“…Patienten mit COVID-19-Pneumonie werden oft intensivbehandlungspflichtig, während das HLÖ eine Erkrankung ist, die selten einer Intensivtherapie bedarf, da sie durch Sauerstoffgabe und Übergang in niedrigere Höhen meist suffizient behandelt werden kann [17].…”

Section: Lungenschäden Nach Covid-19-infektionunclassified

Aufenthalte in großen Höhen nach COVID-19-Infektion − neue Aspekte der höhenmedizinischen Beratung

Grannemann

Röper

2020

Pneumologie

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ZusammenfassungNach Lockerung der Reisefreiheit, welche im Rahmen der COVID-19-Pandemie stark eingeschränkt war, ist mit einem wiedereinsetzenden Tourismus auch in hochgelegene Reiseziele über 2500 Meter zu rechnen.Weiterhin kann man diesem Trend entsprechend davon ausgehen, dass Patienten mit durchgemachter COVID-19-Infektion vor der Reise in große Höhen höhenmedizinische Beratung suchen.Hier wird der reise- und höhenmedizinisch beratende Arzt vor große Herausforderungen gestellt, da er mit dieser speziellen Fragestellung bisher nicht konfrontiert worden ist.Dieser Artikel geht neben den Grundlagen der Höhenkrankheit und des Höhenlungenödems auf die aktuelle Studienlage pulmonologischer Pathologien und Krankheitsverläufe bei COVID-19-Infektion ein und gibt entsprechend dem aktuellen Kenntnisstand Empfehlungen zur höhenmedizinischen Beratung von Patienten nach durchgemachter COVID-19-Infektion.

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To compare the incomparable: COVID-19 pneumonia and high-altitude disease

Cited by 18 publications

References 11 publications

Altitude and COVID‐19: Friend or foe? A narrative review

Altitude and COVID‐19: Friend or foe? A narrative review

The Fundamentals of Respiratory Physiology to Manage the COVID-19 Pandemic: An Overview

Aufenthalte in großen Höhen nach COVID-19-Infektion − neue Aspekte der höhenmedizinischen Beratung

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