Do we have a "best practice" for treating high altitude pulmonary edema?
High-altitude pulmonary edema (HAPE) is a rare, but potentially fatal, non-cardiogenic pulmonary edema that affects unacclimatized lowlanders ascending to altitudes above 2500 m. A review of the literature on the disease suggests that a wide range of strategies is employed for treatment purposes. This situation raises questions as to whether a "best practice" exists for treating HAPE and whether clinicians are using greater measures than necessary to ensure good outcomes. This review considers these issues in greater detail, examining the current state of research and clinical practice in HAPE treatment, addressing important questions raised by documented treatment practices, such as the utility of beta agonists, acetazolamide and diuretics and, finally, proposing reasonable, parsimonious treatment approaches that reflect the setting in which the patient is being treated.
Luks
Andrew M
AM
Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington 91895-6522, USA. aluks@u.washington.edu
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000532:Altitude Sickness / Q000188:drug therapy / Q000628:therapy*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D004232:Diuretics / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D009051:Mountaineering; D010102:Oxygen Inhalation Therapy / Q000379:methods; D017410:Practice Guidelines as Topic / Q000592:standards*; D011322:Primary Prevention / Q000458:organization & administration*; D011654:Pulmonary Edema / Q000188:drug therapy / Q000628:therapy*; D014665:Vasodilator Agents / Q000627:therapeutic use
D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D004232:Diuretics; D014665:Vasodilator Agents