Understanding Acute Respiratory Distress Syndrome in High-Altitude Environments: A Comprehensive Review of Diagnosis and Treatment

Abstract

Approximately 2% of the global population lives above 1500 m, where low atmospheric pressure, decreased oxygen levels, harsh cold and dry conditions, strong radiation, and the effects of climate change present significant health challenges. Residents of these high-altitude areas display physiological adaptions, including smaller body size, enlarged ribs, improved oxygen delivery in hypoxic conditions, and adjustments in oxygen utilization and metabolism. Both acute and chronic hypoxia prevalent in such regions can trigger various diseases by stimulating hypoxia-inducible factors, boosting inflammatory responses, and impairing mitochondrial function. Acute Respiratory Distress Syndrome (ARDS) – a critical respiratory condition associated with high morbidity and mortality – occurs more frequently among the health risks in these environments. Hypoxia is a critical predisposing and aggravating factor for high-altitude ARDS. Despite similarities with its low-altitude counterpart, ARDS in high-altitude areas displays unique pathophysiology and clinical manifestations due to the specific environmental conditions. This review aims to shed light on how high-altitude environments influence the diagnosis and treatment of ARDS, providing a comprehensive understanding of the distinct challenges inherent to these regions.

Incidence, mortality, and predictive factors associated with acute respiratory distress syndrome in multiple trauma patients living in high-altitude areas: a retrospective study in Shigatse

“…This can be attributed to the gradual decrease in atmospheric pressure and oxygen content in the air with increasing altitude. Consequently, individuals in high-altitude areas have undergone physiological adaptations such as enhanced oxygen delivery, and adjustments in oxygen utilization and metabolism ( Guo et al, 2023 ). These adaptations result in significant differences in respiratory physiology and pathology between patients residing in high-altitude and low-altitude regions ( Guo et al, 2023 ; Ortiz et al, 2022 ).…”

“…Consequently, individuals in high-altitude areas have undergone physiological adaptations such as enhanced oxygen delivery, and adjustments in oxygen utilization and metabolism ( Guo et al, 2023 ). These adaptations result in significant differences in respiratory physiology and pathology between patients residing in high-altitude and low-altitude regions ( Guo et al, 2023 ; Ortiz et al, 2022 ). However, there is a lack of reports focusing on the incidence and mortality of ARDS, as well as potential risk factors for early prediction of ARDS in multiple trauma patients living in high-altitude areas.…”

Cold waves and fine particulate matter in high-altitude Chinese cities: assessing their interactive impact on outpatient visits for respiratory disease

“…Cold waves, not only increase the body's stress response and affect physical and cognitive functions but can also induce changes in airway function and bronchoconstriction [7][8][9], thereby exacerbating respiratory disease, such as asthma and chronic obstructive pulmonary disease [10,11]. Additionally, the hypoxic and lowpressure environment in high-altitude areas can trigger various diseases by stimulating hypoxia-inducible factors, enhancing inflammatory responses, and damaging mitochondrial functions, with the impact on health possibly becoming more pronounced during cold wave periods [12][13][14]. Fine particulate matter (PM 2.5 ), as a major component of air pollution, is widely recognised for its aggravating effects on respiratory disease [15].…”