Prevention and treatment of high-altitude pulmonary edema.
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.
Maggiorini
Marco
M
Intensive Care Unit, Department of Internal Medicine, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland. klinmax@usz.unizh.ch <klinmax@usz.unizh.ch>
D000064:Acclimatization / Q000187:drug effects; D000420:Albuterol / Q000031:analogs & derivatives / Q000627:therapeutic use; D000465:Algorithms; D000531:Altitude; D000532:Altitude Sickness / Q000150:complications* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D000818:Animals; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002243:Carbolines / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D009051:Mountaineering; D009543:Nifedipine / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D010879:Piperazines / Q000627:therapeutic use; D011650:Pulmonary Alveoli / Q000187:drug effects; D011651:Pulmonary Artery / Q000503:physiopathology; D011654:Pulmonary Edema / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D011687:Purines / Q000627:therapeutic use; D000068299:Salmeterol Xinafoate; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use; D000068581:Tadalafil; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use
D001993:Bronchodilator Agents; D002243:Carbolines; D005938:Glucocorticoids; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068299:Salmeterol Xinafoate; D000068581:Tadalafil; D003907:Dexamethasone; D000068677:Sildenafil Citrate; D009543:Nifedipine; D000420:Albuterol