Prevention and Treatment of High-Altitude Pulmonary Edema

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Abstract

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.

Section snippets

Slow ascent

Slow ascent is the major measure of prevention and is effective even in susceptible individuals. Indirect evidence came from the observation, that even subjects who developed HAPE more than once upon rapid ascent in the Alps successfully reached altitudes up to 7000 m when the average daily ascent rate above 2000 m does not exceed 350 to 400 m/d.18 The experience of the Indian Army that up to 15% of its soldiers, if airlifted to extreme altitudes, developed HAPE19 but, if acclimatized during

Treatment

Immediate improvement of oxygenation either by supplemental oxygen, hyperbaric treatment,53, 54 or by rapid descent is the treatment of choice for HAPE. For the mountaineer in a remote area without medical care, descent has first priority, whereas the tourist with HAPE visiting a high-altitude plateau in the Andes, Himalayas, or Rocky Mountains may stay at altitude if medical facilities are available. If unable to reach lower altitude for a few days, treatment with nifedipine or sildenafil is

Statement of Conflict of Interest

The author declares that there are no conflicts of interest.

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    Statement of Conflict of Interest: see page 504.

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