title: Managing High-Altitude Pulmonary Edema with Oxygen Alone: Results of a Randomized Controlled Trial.
abstract: Yanamandra, Uday, Velu Nair, Surinderpal Singh, Amul Gupta, Deepak Mulajkar, Sushma Yanamandra, Konchok Norgais, Ruchira Mukherjee, Vikrant Singh, Srinivasa A. Bhattachar, Sagarika Patyal, and Rajan Grewal. High-altitude pulmonary edema management: Is anything other than oxygen required? Results of a randomized controlled trial. High Alt Med Biol. 17:294-299, 2016.-Treatment strategies for management of high-altitude pulmonary edema (HAPE) are mainly based on the observational studies with only two randomized controlled trials, thus the practice is very heterogeneous and individualized as per the choice of treating physician. To compare the response to different modalities of therapy in patients with HAPE in a randomized controlled manner. We conducted an open-label, randomized noninferiority trial to compare three modalities of therapy (Therapy 1: supplemental O2with oral dexamethasone 8 mg q8 hours [n = 42], Therapy 2: supplemental O2with sustained release oral nifedipine 20 mg q8 hours [n = 41], and Therapy 3: only supplemental O2[n = 50]). Bed rest was mandated in all patients. The study was conducted in a cohort of previously healthy young lowlander males at an altitude of 3500 m. Baseline characteristics of the patients were comparable in the study arms. Complete response was defined as clinical and radiological resolution of features of HAPE, no oxygen dependency, a normal 6-minute walk test (6MWT) on 2 consecutive days, and normal two-dimensional echocardiography. Results were compared by analysis of variance using SPSS version 16.0. There was no statistical difference in duration of therapy to complete response between the three groups (Therapy 1: 8.1 ± 4.0 days, Therapy 2: 6.7 ± 3.9 days, Therapy 3: 6.8 ± 3.2 days; p = 0.15). There were no deaths in any of the groups. We conclude that oxygen and bed rest alone are adequate therapy for HAPE and that adjuvant pharmacotherapy with either dexamethasone or nifedipine does not hasten recovery.
authors.affiliation: 1 Department of Internal Medicine, PGIMER , Chandigarh, India .
authors.forename: Uday
authors.initials: U
authors.lastname: Yanamandra
authors.affiliation: 2 Director General Medical Services (Army), Integrated Headquarters, Ministry of Defence, New Delhi, India .
authors.forename: Velu
authors.initials: V
authors.lastname: Nair
authors.affiliation: 3 Deparment of Physiology, Armed Forces Medical College , Pune, India .
authors.forename: Surinderpal
authors.initials: S
authors.lastname: Singh
authors.affiliation: 4 Department of Radiology, Military Hospital , Bhopal, India .
authors.forename: Amul
authors.initials: A
authors.lastname: Gupta
authors.affiliation: 5 Command Hospital, Southern Command, Pune, Maharashtra, India .
authors.forename: Deepak
authors.initials: D
authors.lastname: Mulajkar
authors.affiliation: 6 Department of Medicine, Max Hospital , Mohali, India .
authors.forename: Sushma
authors.initials: S
authors.lastname: Yanamandra
authors.affiliation: 7 Internal Medicine Residency, Michigan State University , East Lansing, Michigan.
authors.forename: Konchok
authors.initials: K
authors.lastname: Norgais
authors.affiliation: 8 Department of Radiology Armed Forces Medical College , Pune, India .
authors.forename: Ruchira
authors.initials: R
authors.lastname: Mukherjee
authors.affiliation: 9 Armed Forces Medical College, Pune, Maharashtra, India .
authors.forename: Vikrant
authors.initials: V
authors.lastname: Singh
authors.affiliation: 3 Deparment of Physiology, Armed Forces Medical College , Pune, India .
authors.forename: Srinivasa A
authors.initials: SA
authors.lastname: Bhattachar
authors.affiliation: 2 Director General Medical Services (Army), Integrated Headquarters, Ministry of Defence, New Delhi, India .
authors.forename: Sagarika
authors.initials: S
authors.lastname: Patyal
authors.affiliation: 5 Command Hospital, Southern Command, Pune, Maharashtra, India .
authors.forename: Rajan
authors.initials: R
authors.lastname: Grewal
authors.affiliation: 10 Director General Armed Forces Medical Services, New Delhi, India .
authors.forename: Bhushan
authors.initials: B
authors.lastname: Chopra
mesh_terms: D000328:Adult; D000531:Altitude; D000532:Altitude Sickness / Q000628:therapy*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy*; D008297:Male; D009543:Nifedipine / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D014665:Vasodilator Agents; D003907:Dexamethasone; D009543:Nifedipine; D010100:Oxygen
keywords: high-altitude pulmonary edema; nifedipine; supplemental oxygen