Treatment of High Altitude Pulmonary Edema at 4240 m in Nepal
High Alt Med Biol. 2007 Summer
Fagenholz PJ, Gutman JA, Murray AF, Harris NS.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Himalayan Rescue Association, Pheriche Clinic, Spring Season, 2006.
Fagenholz, Peter J., Jonathan A. Gutman, Alice F. Murray, and N. Stuart Harris.
Key Words: altitude sickness; pulmonary edema; altitude, mountaineering; rural populations
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.