Do we have a "best practice" for treating high altitude pulmonary edema?

Do we have a "best practice" for treating high altitude pulmonary edema?
High Alt Med Biol. 2008 Summer

Luks AM.
Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA.

Abstract Luks, Andrew M. Do we have a "best practice" for treating high altitude pulmonary edema? High Alt. Med. & Biol. 9:111-114, 2008.-

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.

Mary Ann Liebert

Acute pulmonary edema as a first manifestation of hyperthyroidism in a pregnant woman. Report of one case

Acute pulmonary edema as a first manifestation of hyperthyroidism in a pregnant woman. Report of one case

Rev Med Chil. 2008 Mar

Díaz N R, Silva G D.
Unidad de Cuidados Intensivos de Adultos, Departamento de Cardiología, Clínica Reñaca, Vina Del Mar, Chile. cardio@entelchile.net

We report a 36 year-old pregnant woman who presented with acute pulmonary edema in the absence of preexisting cardiac disease. On admission she was on sinus rhythm and her blood pressure was mildly elevated. No cardiac abnormalities were detected by color Doppler echocardiography and no ischemic changes were seen on the electrocardiogram. Cardiac enzymes were normal. Thyroid function tests were diagnostic for hyperthyroidism. She was treated with propylthiouracil and propranolol and discharged in good conditions seven days after admission. This case emphasizes the need to consider hyperthyroidism as the cause of unexplained pulmonary edema in young patients with no history of heart disease who present with heart failure.

SciELO

Corneal edema after cataract surgery: predisposing factors and corneal graft outcome.

Corneal edema after cataract surgery: predisposing factors and corneal graft outcome.

Acta Ophthalmol. 2008 Jun 5

Claesson M, Armitage WJ, Stenevi U.
Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.

Purpose: Pseudophakic bullous keratopathy (PBK) is one of the main indications for corneal transplantation. Graft survival and visual outcome in this group are often poorer than for other indications. The aim of this study was to find risk factors for developing corneal edema after cataract surgery and factors that influence the subsequent survival of the graft and the visual outcome.

Methods: We carried out an observational, retrospective cohort study using data from the Swedish Cornea Transplant Register and patient medical records. A total of 273 patients whose indication for corneal transplantation was corneal oedema after cataract surgery were included in the study. Multiple logistic regression analysis and, where appropriate, univariate analyses were applied.

Results: A total of 43% of the patients developed persistent corneal oedema immediately after cataract surgery, the main risk factors for which were phacoemulsification and pre-existing endothelial disease. Almost a third (32%) of the transplants for PBK failed within 2 years, for which rejection and other postoperative complications increased the risk. Half (50%) the patients had visual acuity less then 0.1 at 2 years after keratoplasty. Comorbidity, increasing duration of the bullous keratopathy and increasing age affected the visual outcome negatively.

Conclusions: Phacoemulsification was a risk factor for immediate persistent corneal oedema after cataract surgery, although it did not increase the overall risk of developing PBK. However, transplants for immediate PBK had a better survival rate than those for later onset PBK. Shorter duration of PBK and intraocular lens exchange at the time of penetrating keratoplasty increased the likelihood of good visual acuity.

PMID: 18537927 [PubMed - as supplied by publisher]