Treatment of high altitude pulmonary edema at 4240 m in Nepal.
High altitude pulmonary edema (HAPE) is the leading cause of death from altitude illness and rapid descent is often considered a life-saving foundation of therapy. Nevertheless, in the remote settings where HAPE often occurs, immediate descent sometimes places the victim and rescuers at risk. We treated 11 patients (7 Nepalese, 4 foreigners) for HAPE at the Himalayan Rescue Association clinic in Pheriche, Nepal (4240 m), from March 3 to May 14, 2006. Ten were admitted and primarily treated there. Seven of these (6 Nepalese, 1 foreigner) had serious to severe HAPE (Hultgren grades 3 or 4). Bed rest, oxygen, nifedipine, and acetazolamide were used for all patients. Sildenafil and salmeterol were used in most, but not all patients. The duration of stay was 31 +/- 16 h (range 12 to 48 h). Oxygen saturation was improved at discharge (84% +/- 1.7%) compared with admission (59% +/- 11%), as was ultrasound comet-tail score (11 +/- 4 at discharge vs. 33 +/- 8.6 at admission), a measure of pulmonary edema for which admission and discharge values were obtained in 7 patients. We conclude it is possible to treat even serious HAPE at 4240 m and discuss the significance of the predominance of Nepali patients seen in this series.
Fagenholz
Peter J
PJ
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Gutman
Jonathan A
JA
Murray
Alice F
AF
Harris
N Stuart
NS
D000086:Acetazolamide / Q000008:administration & dosage; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives; D000531:Altitude; D000532:Altitude Sickness / Q000150:complications*; D001510:Bed Rest; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009051:Mountaineering; D009390:Nepal; D009543:Nifedipine / Q000008:administration & dosage; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D010879:Piperazines / Q000008:administration & dosage; D011654:Pulmonary Edema / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D011687:Purines / Q000008:administration & dosage; D000068299:Salmeterol Xinafoate; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068299:Salmeterol Xinafoate; D000068677:Sildenafil Citrate; D009543:Nifedipine; D000086:Acetazolamide; D000420:Albuterol