Share cases and questions with Physicians on Medscape consult. High-altitude pulmonary edema responds best when the person descends from their current altitude. 10(11):469-74. Available at https://www.fda.gov/media/136449/download. These agents have profound and varied metabolic effects. N Engl J Med, 346 (21) (2002), pp. It often improves SaO2 modestly within a few minutes. Korzeniewski K, Nitsch-Osuch A, Guzek A, Juszczak D. High altitude pulmonary edema in mountain climbers. The High Altitude Medicine Handbook. J Am Coll Cardiol. [Full Text]. 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. StatPearls [Internet]. 2011. Although HACE presents with similar symptoms as AMS, the cerebral edema can lead to ataxia, confusion, or altered mental status. 9 (4):289-93. 2006 Oct 3; 145(7):497–506. Managing high-altitude pulmonary edema with oxygen alone: results of a randomized controlled trial. Ann Intern Med. To see the full article, log in or purchase access. [4] : Further research is needed before tadalafil or dexamethasone can be recommended over nifedipine for prophylaxis. [Medline]. J Travel Med. 2016 Dec. 17 (4):353-8. High-altitude pulmonary edema (HAPE). Sign up for the free AFP email table of contents. Maggiorini M, Brunner-La Rocca HP, Peth S, et al. Fischer R, Lang SM, Bergner A, Huber RM. April 5, 2020; Accessed: April 6, 2020. 2. Acetazolamide promotes renal excretion of … Acute altitude illness comprises acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). High altitude illness (HAI) is a spectrum of conditions characterized by the nausea, vomiting, and sleep disturbances typical of acute mountain sickness (AMS), the ataxia and eventual coma seen in high altitude cerebral edema (HACE), and the cough, dyspnea, and eventual death typical of high altitude pulmonary edema (HAPE). Curr Opin Investig Drugs 2007; 8:226. Because the risk of acute altitude illness depends on acclimatization, sleeping altitude is more important than altitude reached while awake. Prevention of high-altitude pulmonary edema by nifedipine. Nifedipine , a medication for high blood pressure, has been shown to be beneficial for high-altitude pulmonary edema. Anaesthesia. [Full Text]. Hartmann G, Tschop M, Fischer R, et al. People with a history of AMS who make a one-day ascent to a sleeping altitude of 8,200 to 9,200 ft have a moderate risk of AMS. You should also: avoid flying directly to areas of high altitude, if possible; take 2 to 3 days to get used to high altitudes before going above 2,500m Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. 24 (1):32-6. 1631-1636. If you ascend to altitudes above 8,000 feet, you will be in danger of developing uncomfortable or dangerous symptoms from the change in altitude. [Medline]. for: Medscape. Nifedipine is used in HAPE for pulmonary vasodilation. [Medline]. [Full Text]. Worcester S. Is protocol-driven COVID-19 ventilation doing more harm than good?. Pulm Med. 2012 Mar. Maggiorini M, Brunner-La Rocca HP, Peth S, et al. 8(2):139-46. Treatment of high altitude pulmonary edema at 4240 m in Nepal. afpserv@aafp.org for copyright questions and/or permission requests. High-altitude pulmonary edema (HAPE) is a lethal, noncardiogenic form of pulmonary edema that afflicts susceptible individuals after rapid as-cent to high altitude above 2,500 m. Prevention of HAPE is achieved most effectively by gradual ascent allowing time for proper acclimatiza-tion. Author disclosure: No relevant financial affiliations. 2017 Jan. 26 (143):[Medline]. Courtesy of High Altitude Medicine & Biology (PMID: 27768392, online at https://www.liebertpub.com/doi/full/10.1089/ham.2016.0008). Am Fam Physician. Burlington, MA: Jones & Bartlett Learning; 2021. ch 38. N Engl J Med. Intensive Care Med. High-altitude … Kilimanjaro [19,341 ft (5,895 m)] in fewer than seven days); or (3) ascend to a sleeping altitude above 9,800 ft, then sleep more than 1,600 ft above the previous night's altitude without allowing a day off to acclimatize. [Full Text]. Axial computed tomography (CT) pulmonary angiogram showing thrombi as filling defects in the right main pulmonary artery (right arrow) extending into its branch and in the distal left pulmonary artery (left arrow) with extension into its superior branch. [Medline]. 2000 Mar. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. If you log out, you will be required to enter your username and password the next time you visit. The recommendation for its use is strongest for individuals with a history of HAPE. Prog Cardiovasc Dis. [Medline]. High-altitude pulmonary edema (HAPE) is a life-threatening noncardiogenic form of pulmonary ede-ma (PE) that afflicts susceptible persons after rapid ascent to high altitude above 2500 m. Its patho-genesis is related to increased sympathetic tone, exaggerated hypoxic pulmonary vasoconstriction, Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine [Medline]. Rohit Goyal, MD is a member of the following medical societies: American College of Chest Physicians, American Medical Association, American Thoracic SocietyDisclosure: Nothing to disclose. / a For individuals ascending to and remaining at a given elevation, after arrival at the target elevation, the medication should be continued for 2 d in Wilderness Environ Med. / afp Medications that lower the pulmonary-arterial blood pressure are effective in the prevention of high-altitude pulmonary edema. [Guideline] Sorbello M, El-Boghdadly K, Di Giacinto I, et al, for the Societa Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) Airway Research Group, The European Airway Management Society. High altitude pulmonary edema (HAPE). A chest X-ray will likely … Prevention of high-altitude pulmonary edema by nifedipine. All rights Reserved. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update. 179 (2-3):294-9. Courtesy of Wikipedia (https://en.wikipedia.org/wiki/File:Chest_XR_of_HAPE.png). Want to use this article elsewhere? Oxygen, if available, should be provided. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. High Alt Med Biol. [Full Text]. 3rd ed. Chest X-ray. van Patot MC, Leadbetter G 3rd, Keyes LE, Maakestad KM, Olson S, Hackett PH. High-Altitude Pulmonary Edema. The aim of this article was to present the relevant details concerning epidemiology, pathophysiology, clinical symptoms, prevention, and treatment of high altitude pulmonary edema among climbers in the mountain environment. Wilkins MR, Ghofrani HA, Weissmann N, Aldashev A, Zhao L. Pathophysiology and treatment of high-altitude pulmonary vascular disease. [Medline]. [Medline]. Klaus-Dieter Lessnau, MD, FCCP Former Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital High altitude pulmonary edema: Known for short as HAPE, the accumulation in the lungs of extravascular fluid (fluid outside of blood vessels) at high altitude, a consequence of rapid altitude ascent, especially when that ascent is accompanied by significant exercise.. HAPE leads to dyspnea (shortness of breath), cough, tachycardia (fast heart rate) and decreased arterial … A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Symptoms may include headaches, vomiting, tiredness, trouble sleeping, and dizziness. Copyright © 2020 by the American Academy of Family Physicians. 2000 Mar 15. Available at https://www.medscape.com/viewarticle/928160. Medscape Medical News. Pulmonary arterial systolic pressure and susceptibility to high altitude pulmonary edema. Bartsch P, Maggiorini M, Ritter M, Noti C, Vock P, Oelz O. The Wilderness Medical Society (WMS) advises that diuretics or acetazolamide should not be used for treatment of HAPE, and it makes no recommendation regarding beta-agonists or dexamethasone for HAPE treatment due to insufficient/lack of data. 100(3):972-80. 145(7):497-506. Gregory Tino, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic SocietyDisclosure: Nothing to disclose. [Medline]. [33, 34], In general, acetazolamide facilitates acclimatization, but this agent should not be relied on as the sole preventive agent in individuals with known HAPE susceptibility. Laurie A Ward, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology, National Kidney FoundationDisclosure: Nothing to disclose. Stress Doppler echocardiography for identification of susceptibility to high altitude pulmonary edema. In those with no prior history of HAPE who ascend to 4500m the incidence is relatively low, ranging from 0.01-0.2%. At higher altitudes, the pressure of the air around you (barometric pressure) decreases so there is less oxygen in surrounding air. Altitude sickness, the mildest form being acute mountain sickness (AMS), is the negative health effect of high altitude, caused by rapid exposure to low amounts of oxygen at high elevation. The Centers for Disease Control and Prevention (CDC) strongly recommends acetazolamide prophylaxis in all individuals with a prior history of HAPE or HACE, as well as with the following 131 (6):582-90. Deshwal R, Iqbal M, Basnet S. Nifedipine for the treatment of high altitude pulmonary edema. Nifedipine, for example, can be administered at a rate of 60mg of a timed-release preparation daily, in 2 or 3 divided doses. 101/No. [Medline]. Get Permissions, Access the latest issue of American Family Physician. Mir Mustafa Ali Deccan College of Medical Sciences, Owaisi Hospital and Research Center, Princess Esra HospitalDisclosure: Nothing to disclose. This website also contains material copyrighted by 3rd parties. Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care MedicineDisclosure: Nothing to disclose. [Full Text]. Wilderness Environ Med. [4] : The CDC recommends the following pharmacologic agents and regimens for HAPE prophylaxis Effects of altitude and exercise on pulmonary capillary integrity: evidence for subclinical high-altitude pulmonary edema. She had continued ascending despite experiencing mild altitude symptoms at Namche (3440 m), with considerably worsened symptoms at Tengboche (3860 m). Gallegos A. COVID-19 daily: Ventilator protocols questioned, physician rights. This article covers its milder form, Acute Mountain Sickness (AMS), as well as the more serious conditions of HACE (High-Altitude Cerebral Edema) and HAPE (High-Altitude Pulmonary Edema). Zhou Q. 2008 Winter. [Medline]. [Medline]. 2011 Dec 15. / Vol. PDE-5-esterase inhibitors, like tadalafil at 10 mg by mouth twice a day can also be used. It is not used in the treatment of this condition. In the setting of concomitant HAPE and HACE, WMS recommends adding dexamethasone to the treatment regimen for patients with HAPE and neurologic dysfunction that does not resolve rapidly with administration of supplemental oxygen and improvement in the patient’s oxygen saturation. Wilderness Environ Med. This clinical content conforms to AAFP criteria for continuing medical education (CME). 2013 Mar. The most studied and preferred medication for prevention of HAPE is nifedipine, a pulmonary vasodilator which prevents the altitude induced pulmonary hypertension. High Alt Med Biol. In normal lungs, air sacs (alveoli) take in oxygen and release carbon dioxide. Pandey P, Lohani B, Murphy H. Pulmonary embolism masquerading as high altitude pulmonary edema at high altitude. [Guideline] US Food and Drug Administration. Eur J Med Res. Acetazolamide promotes renal excretion of bicarbonate, which stimulates respiration. Previous: Galcanezumab (Emgality) for Migraine and Cluster Headaches, Home 5:15126. Guo L, Tan G, Liu P, et al. [Medline]. [2, 3] Furthermore, WMS indicates there is no established role for acetazolamide, beta-agonists, diuretics, or dexamethasone in the treatment of HAPE, although dexamethasone should be considered where there is concern for concomitant high-altitude cerebral edema (HACE). Symptoms of AMS, the most common form of altitude illness, include headache, nausea, vomiting, fatigue, dizziness, and insomnia. 209:33-8. [Full Text]. Nancy Caroline's Emergency Care in the Streets Advantage Package (Canadian Edition). Unacclimatized people are at high risk of acute altitude illness when ascending above 8,200 ft (2,500 m), but AMS can occur as low as 6,500 ft (2,000 m). 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