Clinical, Biochemical, Therapeutic, and Complication Strategy of High-Altitude Pulmonary Edema: Update from Western Himalayas
Krishan Singh, Santosh Kumar Singh, Vani Singh, Ajai Kumar Tentu, A. K. Naik, Nidhi Singh, Gaurav Joshii
Keywords :
High altitude, oxygen saturation, pulmonary edema
Citation Information :
Singh K, Singh SK, Singh V, Tentu AK, Naik AK, Singh N, Joshii G. Clinical, Biochemical, Therapeutic, and Complication Strategy of High-Altitude Pulmonary Edema: Update from Western Himalayas. Indian J Respir Care 2021; 10 (1):35-40.
Introduction: People traveling to high altitudes (HAs) for work or pleasure are increasing day by day. The rewards of such travel are generally at the risk of developing of acute altitude illnesses and/or worsening of underlying medical problems. The present study was undertaken in a hospital at 11,500 feet to get updated information on the wide clinical spectrum of patients of high-altitude pulmonary edema (HAPE).
Patients and Methods: The study was carried out at a general hospital located at 11,500 feet. The total number of study participants was 151. They were divided into two groups: those who were entering HA for the first time were 17 participants and those who had spent several months at HA 134 patients. All patients in the second group had been completely acclimatized before going down to sea level. The Lake Louis Criteria were taken as the basis for the diagnosis of HAPE.
Results: Pulmonary edema was the most common serious illness seen at HA. Majority of the patients presented at 72–96 h after induction to HA. The common symptoms were breathlessness, cough, and headache at rest. In addition, all patients complained to a varying extent of one or more of the following symptoms: dyspnea, cough, fever, chest pain, dizziness, etc., The majority of the patients showed leukocytosis. Pneumonitis may be a predisposing factor or develop secondary to pulmonary edema.
Conclusion: Pulmonary edema was the most common serious illness seen at HA. The common symptoms were breathlessness, cough, and headache at rest. The understanding of HAPE has changed since its emergence in the field of diagnosis, pathophysiology, complications, and therapeutic modalities.
Dumont L, Mardirosoff C, Tramer MR. Efficacy and harm of pharmacological prevention of acute mountain sickness: Quantitative systemic review. BMJ 2000;321:267-72.
Sartori C, Allerman Y, Duplain H, Lepori M, Egli M, Lipp E, et al. Salmeterol for the prevention of high altitude pulmonary oedema. N Engl J Med 2002;346:1631-6.
Basnyat B, Subedi D, Sleggs J, Lemaster J, Bhasyal G, Aryal B, et al. Disoriented and ataxic pilgrims: An epidemiological study of acute mountain sickness and high-altitude cerebral edema at a sacred lake at 4300 m in the Nepal Himalayas. Wilderness Environ Med 2000;11:89-93.
Menon ND. High-altitude pulmonary edema: A clinical study. N Engl J Med 1965;273:66-73.
Hultgren HN, Marticorena EA. High altitude pulmonary edema. Epidemiologic observations in Peru. Chest 1978;74:372-6.
Director General Armed Forces Medical Services. Problems of High Altitude. New Delhi: Director General Armed Forces Medical Services; 1997. Memorandum 140.
Hackett PH, Roach RC, Schoene RB, Harrison GL, Mills JW. Abnormal control of ventilation in high-altitude pulmonary edema. J Appl Physiol 1988;64:1268-72.
Hull RD, Raskob GE, Carter CJ, Coates G, Gill GJ, Sackett DL, et al. Pulmonary embolism in outpatients with pleuritic chest pain. Arch Intern Med 1988;148:838-44.
Bell WR, Simon TL, DeMets DL. The clinical features of submassive and massive pulmonary emboli. Am J Med 1977;62:355-60.
Hull RD, Hirsh J, Carter CJ, Jay RM, Dodd PE, Ockelford PA, et al. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med 1983;98:891-9.
Bounameaux H, Slosman D, de Moerloose P, Reber G. Laboratory diagnosis of pulmonary embolism: Value of increased levels of plasma D-dimer and thrombin-antithrombin III complexes. Biomed Pharm Uother 1989;43:385-88.
Heit JA, Minor TA, Andrews JC, Larson DR, Li H, Nichols WL. Determinants of plasma fibrin D-dimer sensitivity for acute pulmonary embolism as defined by pulmonary angiography. Arch Pathol Lab Med 1999;123:235-40.
Kearon C, Ginsberg JS, Douketis J, Turpie AG, Bates SM, Lee AY, et al. An evaluation of D-dimer in the diagnosis of pulmonary embolism: A randomized trial. Ann Intern Med 2006;144:812-21.
Oelz O, Maggiorini M, Ritter M, Waber U, Jenni R, Vock P, et al. Nifedipine for high altitude pulmonary oedema. Lancet 1989;2:1241-4.
Deshwal R, Iqbal M, Basnet S. Nifedipine for the treatment of high altitude pulmonary edema. Wilderness Environ Med 2012;23:7-10.
Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med 2014;25:S4-14.
Urner M, Herrmann IK, Booy C, Roth-Z’ Graggen B, Maggiorini M, Beck-Schimmer B. Effect of hypoxia and dexamethasone on inflammation and ion transporter function in pulmonary cells. ClinExp Immunol 2012;169:119-28.
Siebenmann C, Bloch KE, Lundby C, Nussbamer-Ochsner Y, Schoeb M, Maggiorini M. Dexamethasone improves maximal exercise capacity of individuals susceptible to high altitude pulmonary edema at 4559 m. High Alt Med Biol 2011;12:169-77.
Jones BE, Stokes S, McKenzie S, Nilles E, Stoddard GJ. Management of high altitude pulmonary edema in the Himalaya: A review of 56 cases presenting at Pheriche medical aid post (4240 m). Wilderness Environ Med 2013;24:32-6.
Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, et al. Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness. Wilderness Environ Med 2010;21:146-55.
Marticorena E, Hultgren HN. Evaluation of therapeutic methods in high altitude pulmonary edema. Am J Cardiol 1979;43:307-12.
Zafren K, Reeves JT, Schoene R. Treatment of high-altitude pulmonary edema by bed rest and supplemental oxygen. Wilderness Environ Med 1996;7:127-32.
Maggiorini M, Brunner-La Rocca H, Peth S, Fischler M, Böhm T, Bernheim A, et al. Both Tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema. Ann Int Med 2006;145:497.
Leshem E, Caine Y, Rosenberg E, Maaravi Y, Hermesh H, Schwartz E. Tadalafil and acetazolamide versus acetazolamide for the prevention of severe high-altitude illness. J Travel Med 2012;19:308-10.
Höhne C, Pickerodt PA, Francis RC, Boemke W, Swenson ER. Pulmonary vasodilation by acetazolamide during hypoxia is unrelated to carbonic anhydrase inhibition. Am J Physiol Lung Cell Mol Physiol 2007;292:L178-84.
Teppema LJ, Balanos GM, Steinback CD, Brown AD, Foster GE, Duff HJ, et al. Effects of acetazolamide on ventilatory, cerebrovascular, and pulmonary vascular responses to hypoxia. Am J Respir Crit Care Med 2007;175:277-81.