Treatment of High Altitude Pulmonary Edema at 4240 m in Nepal

Fagenholz, Peter J.; Gutman, Jonathan A.; Murray, Alice F.; Harris, N. Stuart

doi:10.1089/ham.2007.3055

Cited by 62 publications

(45 citation statements)

References 24 publications

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“…Based on a small, uncontrolled study [133], sustained-release nifedipine is the preferred agent for this purpose, while anecdotal reports suggest that phosphodiesterase-5 inhibitors may be useful as well (table 2). Cases series describe concurrent use of pulmonary vasodilators, acetazolamide and inhaled β 2-agonists in HAPE treatment [134,135], but there are no data to support this approach. While very early reports described their use in HAPE [136], diuretics are not part of standard protocols because many patients are volume depleted at the time of their illness, and diuretic administration increases the risk of hypotension.…”

Section: Hapementioning

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: Hapementioning

confidence: 99%

Acute high-altitude sickness

2017

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“…[27][28][29][30][31][32][33] However, much of this work was conducted independently and is not well documented, leaving the larger surgical community unaware of prior work, fundraising efforts, and actual effect. To develop a cohesive and effective academic GSI, the first step was to inventory the collective experiences and gauge the interest level of the department's faculty, fellows, and residents.…”

Section: Taking Stock: a Departmental Surveymentioning

confidence: 99%

Building a Global Surgery Initiative Through Evaluation, Collaboration, and Training: The Massachusetts General Hospital Experience

Chao

Riesel

Anderson

et al. 2015

Journal of Surgical Education

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“…Without either oxygen or descent, portable hyperbaric chambers [ 224 ] or a continuous positive airway pressure "helmet" [ 225 ] can be initiated. Treatment with slow release nifedipine should be started until descent is underway [ 23 ].…”

Section: Treatmentmentioning

confidence: 99%

High-Altitude Pulmonary Edema (HAPE)

Schoene

Swenson

2013

High Altitude

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Much of the clinical impact of acute altitude illnesses stems from fl uid accumulation in interstitial spaces and nowhere is this more apparent than in the lungs as the edema escapes into the alveoli to cause life-threatening hypoxemia. This chapter will update our knowledge of HAPE over the past decade about the vasculature, alveolar epithelium, innervation, immune response, and genetics of the lung in hypoxia, as well as prophylactic and therapeutic strategies to reduce the toll of this most common alpine life-threatening illness. 406extend to HPV, would predict greater HAPE susceptibility. Although HAPE can develop in sedentary persons, exercise [ 6 ] and its pulmonary hemodynamic consequences (discussed below) are important precipitating factors.Symptoms, signs, and physiologic changes in lung function typical of pulmonary edema [ 1 -3 , 7 ] evolve in 2-4 days after ascent, often preceded or accompanying AMS (see Chap. 20 ), but can occur later with further ascent. Arterial saturations can fall as low as 40 % and PaO 2 s in the low 20 mmHg range. HAPE in its severest stage with profound hypoxemia can lead to high-altitude cerebral edema [ 8 ]. Repeat occurrences of HAPE do not always involve infi ltrates in the same areas, which suggests that fi xed structural aspects of lung parenchyma or vessels do not account for the timing of edema or its locale [ 9 ]. A special exception is unilateral absence of a pulmonary artery, in which edema always occurs in the contralateral lung receiving the entire cardiac output [ 10 ].It has been suggested that many persons (50-75 %) may have subclinical HAPE that resolves spontaneously despite remaining at altitude [ 11 -13 ]. This incidence equals that of AMS, which itself can cause mild gas exchange impairment [ 14 ] by unknown mechanisms perhaps related to altered autonomic infl uences on the pulmonary circulation and/or airways leading to ventilation-perfusion mismatching. Subclinical HAPE may be considerably overestimated without radiography [ 15 ] because indirect measures of interstitial edema such as spirometry, closing volume, and/or transthoracic impedance can vary for other reasons related to mountaineering including intense exercise and increased cardiac output, cold/dry air-induced bronchoconstriction, and hypocapnia [ 16 ]. With radiographically mild HAPE, only modest abnormalities were detectable [ 15 ] suggesting many lung function parameters are not sensitive enough to detect small changes in interstitial fl uid and may require highresolution tissue density measurements by CT or MR imaging. Reentry HAPE occurs when longterm high-altitude residents return to high altitude following a brief low-altitude sojourn. It has a strong familial basis and affl icts children more than adults [ 17 ], perhaps due to a twofold greater magnitude of HPV in preteen children (age 6-9) compared to teenagers (age 14-16) when tested 40 h after ascent to high altitude [ 18 ]. PathophysiologyFrom its fi rst modern descriptions, pulmonary hypertension and HAPE have been inex...

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Treatment of High Altitude Pulmonary Edema at 4240 m in Nepal

Cited by 62 publications

References 24 publications

Acute high-altitude sickness

Acute high-altitude sickness

Building a Global Surgery Initiative Through Evaluation, Collaboration, and Training: The Massachusetts General Hospital Experience

High-Altitude Pulmonary Edema (HAPE)

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