Clinical, biochemical, therapeutic, and complication strategy of high-altitude pulmonary edema: Update from Western Himalayas (original) (raw)
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m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 1 ( 2 0 1 5 ) 3 4 5 -3 5 1 a b s t r a c t Background: The criteria used for diagnosing high altitude illnesses are largely based on Western literature. This study was undertaken to define objective, simple and reliable diagnostic criteria for high altitude pulmonary edema (HAPE) in Indian soldiers at altitudes between 2700 m and 3500 m. Methods: Clinical data of 235 cases of HAPE that occurred between 2700 m and 3500 m were analysed. Receiver operator characteristic (ROC) curve analysis was used to select simple clinical parameters suitable for the diagnosis of HAPE at peripheral medical facilities. Cut-off values and their reliability for the diagnosis of HAPE were defined. Results: HAPE occurred 2.8 AE 2.2 days after arrival at altitudes between 2700 m and 3500 m.
Prevention and Treatment of High-Altitude Pulmonary Edema
Progress in Cardiovascular Diseases, 2010
We distinguish two forms of high altitude illness, a cerebral form called acute mountain sickness and a pulmonary form called high-altitude pulmonary edema (HAPE). Individual susceptibility is the most important determinant for the occurrence of HAPE. The hallmark of HAPE is an excessively elevated pulmonary artery pressure (mean pressure 36-51 mm Hg), caused by an inhomogeneous hypoxic pulmonary vasoconstriction which leads to an elevated pulmonary capillary pressure and protein content as well as red blood cell-rich edema fluid. Furthermore, decreased fluid clearance from the alveoli may contribute to this noncardiogenic pulmonary edema. Immediate descent or supplemental oxygen and nifedipine or sildenafil are recommended until descent is possible. Susceptible individuals can prevent HAPE by slow ascent, average gain of altitude not exceeding 300 m/d above an altitude of 2500 m. If progressive high altitude acclimatization would not be possible, prophylaxis with nifedipine or tadalafil for long sojourns at high altitude or dexamethasone for a short stay of less then 5 days should be recommended. (Prog Cardiovasc Dis 2010;52:500-506)
High but not that High: Pulmonary Edema at Intermediate Altitude
Journal of Case Reports, 2018
Background: Pulmonary edema is a life-threatening condition which results from a persistent imbalance between the forces that drive water into the air space in the alveoli and the physiologic mechanisms that remove it. This is generally observed with rapid ascent to altitudes greater than 2500 m in absence of acclimatization in otherwise healthy individuals. Case Report: A 35 year old female tourist hailing from Hyderabad developed severe breathlessness, dizziness and chest discomfort on the second day of her trip to Shimla, Himachal Pradesh. This was associated with drop in saturation and bilateral coarse crepitations in all lung fields. She was initially managed with O 2 inhalation, bilevel positive airway pressure and furosemide. SpO 2 increased to 84% gradually. Following her chest X ray which showed bilateral lung infiltrates, she was started on morphine, furosemide, dexamethasone and referred to a tertiary care hospital in the plains. On follow up at the hospital she was told to have improved drastically in terms of saturation, hemodynamics and chest X-ray picture. Conclusion: Even though high altitude sickness manifests at altitudes higher than 2500 m, that too on rapid ascent, cases have been reported at lower heights too. And the definitive treatment is transferring the patients to lowlands.
Clinico-epidemiological profile of high altitude pulmonary edema
International Journal Of Community Medicine And Public Health
Background: With increase in the footfall to mountainous areas for occupational and recreational purposes, tackling the burden of high-altitude illnesses is a growing public health challenge. High-altitude pulmonary edema (HAPE) is a serious medical condition with peculiar epidemiological characteristics. HAPE is a significant cause of morbidity and mortality among Indian soldiers posted to high-altitude areas. Aims and objectives of the study were to study the common clinical presentation of HAPE among Indian army soldiers and to study the association between induction patterns and acclimatization status with the onset of HAPE.Methods: An observational study was undertaken to study the clinical and epidemiological characteristics of all cases of HAPE from years 2016 to 2019, among Indian army soldiers posted to high-altitude areas in Ladakh. Diagnosis was made by the Lake-Louise consensus criteria. Data was entered in Microsoft Excel and descriptive and inferential statistical tool...
2013
Objective.-The purpose of this study was to review the patient characteristics and management of 56 cases of high altitude pulmonary edema at the Pheriche Himalayan Rescue Association Medical Aid Post, and to measure the use of medications in addition to descent and oxygen. Methods.-In a retrospective case series, we reviewed all patients diagnosed clinically with high altitude pulmonary edema during the 2010 Spring and Fall seasons. Nationality, altitude at onset of symptoms, physical examination findings, therapies administered, and evacuation methods were evaluated. Results.-Of all patients, 23% were Nepalese, with no difference in clinical features compared with non-Nepalese patients; 28% of all patients were also suspected of having high altitude cerebral edema. Symptoms developed in 91% of all patients at an altitude higher than the aid post (median altitude of onset of 4834 m); 83% received oxygen therapy, and 87% received nifedipine, 44% sildenafil, 32% dexamethasone, and 39% acetazolamide. Patients who were administered sildenafil, dexamethasone, or acetazolamide had presented with significantly lower initial oxygen saturations (P Յ .05). After treatment, 93% of all patients descended; 38% descended on foot without a supply of oxygen. Conclusions.-A significant number of patients presenting to the Pheriche medical aid post with high altitude pulmonary edema were given dexamethasone, sildenafil, or acetazolamide in addition to oxygen, nifedipine, and descent. This finding may be related to perceived severity of illness and evacuation limitations. Although no adverse effects were observed, the use of multiple medications is not supported by current evidence and should not be widely adopted without further study.
PURPOSE/AIM The purpose of this poster is: 1. Illustrate radiographic findings of high-altitude pulmonary edema (HAPE) through the presentation of a series of cases. 2. Review physiopathological aspects of HAPE 3.Review of radiologic manisfestations os HAPE as described in scientific publications CONTENT ORGANIZATION 1. Definition of HAPE 2. Presentation of series of cases 3. Physiopathology of HAPE 4. Review of reported findings of HAPE 5. Analysis of findings of our series of cases 6. Conclusions. SUMMARY High altitude pulmonary edema is a rare entity usually encountered in high altitude sites. We present a series of 10 cases presented at our institution which lies at 2600 mt . Airspace consolidation, most frequently involving upper zones of the lungs, which resolves 48-72 hours soley with oxigen therapy are the characteristic radiographic features. There is no altitude threshold o any time limit for its occurence. Elevation of arterial capillary pressure accounts for this edema.
High Altitude Pulmonary Edema: An Update on Omics Data
High altitude pulmonary edema (HAPE) is a serious pathological condition associated with rapid ascent to high altitude occurring in non-acclimatized but otherwise healthy individuals. Decades of scientific studies on HAPE have unraveled the disease pathology, diagnosis and therapeutic interventions yet, the etiology is still unknown. A vast scientific literature is available on HAPE for a quick reference of clinicians, researchers and academicians. Perhaps, the view of mountain travelers is different and their anticipation of HAPE susceptibility comprises of personal experience. Ever-increasing number of visitors to high altitude demands the possibility of HAPE susceptibility screening, however, scientific community is yet to find a staunch solution. This review is an update of recent information on HAPE susceptibility indicators from genomics, proteomics and metabolomics as well as information pertaining to treatment/prognosis of HAPE.
Delayed-Onset High Altitude Pulmonary Edema: A Case Report
Wilderness & Environmental Medicine
High altitude pulmonary edema (HAPE) is a life-threatening altitude illness that usually occurs in insufficiently acclimatized climbers in the first few days at altitudes above 2500 m. Acetazolamide is recommended for prophylaxis of acute mountain sickness, but a role for acetazolamide in the prevention of HAPE has not been established. We report a case of a trekker with previous high altitude experience who developed HAPE 8 d after arrival to altitude despite what was believed to be a conservative ascent profile.
High altitude pulmonary edema among
2016
The process of development of guidelines for diagnosis and management of patients of chronic obstructive pulmonary disease (COPD) in India was undertaken as a joint exercise of the two National Pulmonary Associations (Indian Chest Society (ICS) and