Clinico-epidemiological profile of high altitude pulmonary edema (original) (raw)
Related papers
Indian Journal of Respiratory Care
There is an increase in the number of people traveling to high altitudes (HAs) either for work or pleasure. The rewards of such travel are generally in the form of risk of developing acute altitude illnesses or worsening of underlying medical problems. The purpose of physiology in medicine is to provide scientific information that can be used as a basis for counseling patients for these purposes. It has been seen that the symptoms of HA pulmonary edema (HAPE) ordinarily happen a few days after landing in height, and it involves dyspnea with exertion, advancing to dyspnea at rest, a dry cough, weakness, and poor exercise tolerance. [1] If the disease worsens without treatment, severe dyspnea and frank pulmonary edema are obvious, with coma and death following. Early clinical signs of the condition include tachycardia and tachypnea, mild pyrexia, basal crepitations, and dependent edema. In addition, patients generally have decreased oxygen saturation than unaffected people, but the degree of desaturation by itself has not been taken as the reliable sign of HAPE. [2] HAPE rarely occurs below 2500 m. Generally, residents of low altitudes are susceptible to HAPE if acutely exposed to HA. Some suffer
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.
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.
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
IOSR Journals , 2019
High altitude and associated high altitude illnesses have always been an issue of concern especially in western Himalayan region and northern India. Ladakh has been stated to cause maximum number of cases of high altitude illness. This study was taken to assess the incidence of High altitude illness (HAI) among low landers adult males on rapid exposure to high altitude region and the association of altitude range and acclimatization schedule. An observational study was done prospectively in Ladakh region and all the reported cases of high altitude illness were assessed for two consecutive years. The overall incidence of high altitude illness were 7.6/1000 and 9.2/1000 in two consecutive years. Maximum number of acute mountain sickness (AMS) were reported between 0-2 days of acclimatization and 11500 to 13500 ft altitude range while the number of High altitude pulmonary edema (HAPO) cases reported between 3-5 days of acclimatization and at 11500 to 13500 ft altitude range. Rapid induction and gain in altitude of more than 13500 ft was found to have a direct association with high altitude illness.
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.
High altitude pulmonary edema in an experienced mountaineer. possible genetic predisposition
The western journal of emergency medicine, 2014
High altitude pulmonary edema (HAPE) is a form of high altitude illness characterized by cough, dyspnea upon exertion progressing to dyspnea at rest and eventual death, seen in patients who ascend over 2,500 meters, particularly if that ascent is rapid. This case describes a patient with no prior history of HAPE and extensive experience hiking above 2,500 meters who developed progressive dyspnea and cough while ascending to 3,200 meters. His risk factors included rapid ascent, high altitude, male sex, and a possible genetic predisposition for HAPE.
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.
Effect of Altitude and Duration of Stay on Pulmonary Function in Healthy Indian Males
Defence Life Science Journal
The study was carried out with the objective to investigate the effect of varying altitude and duration of exposure on blood pressure, heart rate and lung function parameters in healthy Indian soldiers after adopting proper acclimatization schedule. For this purpose 17 soldiers of Indian Army, weight and height matched, were studied after obtaining written consent. Recording of Blood pressure (systolic and diastolic), heart rate and lung function variables (FVC, FEV1, FEV1/FVC%, MVV, FEF25-75%, MEF 25%, MEF 50%, MEF 75%, PEF) were measured at basal (290m), 800m, 3200m (day 10 and day 20) and upon de-induction. Our results demonstrate that with increasing altitude FVC declined, FEV1 did not change and due to these changes FEV1/FVC% increased. Expiratory flow rates including MEF 25%, MEF50% MEF 75%, PEF and mean expiratory flow rate (FEF25-75%) increased upon induction to high altitude. This increase may be due to reduction in air density causing less air resistance which accelerates ...
Consensus Statement on Chronic and Subacute High Altitude Diseases
High Altitude Medicine & Biology, 2005
Consensus on high altitude diseases. High Alt Med Biol 6: [147][148][149][150][151][152][153][154][155][156][157] 2005.-This is an international consensus statement of an ad hoc committee formed by the International Society for Mountain Medicine (ISMM) at the VI World Congress on Mountain Medicine and High Altitude Physiology (Xining, China; and represents the committee's interpretation of the current knowledge with regard to the most common chronic and subacute high altitude diseases. It has been developed by medical and scientific authorities from the committee experienced in the recognition and prevention of high altitude diseases and is based mainly on published, peer-reviewed articles. It is intended to include all legitimate criteria for choosing to use a specific method or procedure to diagnose or manage high altitude diseases. However, the ISMM recognizes that specific patient care decisions depend on the different geographic circumstances involved in the development of each chronic high altitude disease. These guidelines are established to inform the medical services on site who are directed to solve high altitude health problems about the definition, diagnosis, treatment, and prevention of the most common