Management of High Altitude Pulmonary Edema in the Himalaya: A Review of 56 Cases Presenting at Pheriche Medical Aid Post

Management of High Altitude Pulmonary Edema in the Himalaya: A Review of 56 Cases Presenting at Pheriche Medical Aid Post (4240 m).

Oct 2012

Jones BE, Stokes S, McKenzie S, Nilles E, Stoddard GJ.

Source

Department of Pulmonary/Critical Care Medicine, University of Utah, Salt Lake City, UT. Electronic address: barbara.jones@hsc.utah.edu.

Abstract

OBJECTIVE: The purpose of this study was to review the patient characteristics and management of 56 cases of high altitude pulmonary edema at the Pheriche Himalayan Rescue Association Medical Aid Post, and to measure the use of medications in addition to descent and oxygen. 

METHODS: In a retrospective case series, we reviewed all patients diagnosed clinically with high altitude pulmonary edema during the 2010 Spring and Fall seasons. Nationality, altitude at onset of symptoms, physical examination findings, therapies administered, and evacuation methods were evaluated. 

RESULTS: Of all patients, 23% were Nepalese, with no difference in clinical features compared with non-Nepalese patients; 28% of all patients were also suspected of having high altitude cerebral edema. Symptoms developed in 91% of all patients at an altitude higher than the aid post (median altitude of onset of 4834 m); 83% received oxygen therapy, and 87% received nifedipine, 44% sildenafil, 32% dexamethasone, and 39% acetazolamide . Patients who were administered sildenafil, dexamethasone, or acetazolamide had presented with significantly lower initial oxygen saturations (P ≤ .05). After treatment, 93% of all patients descended; 38% descended on foot without a supply of oxygen. 

CONCLUSIONS: A significant number of patients presenting to the Pheriche medical aid post with high altitude pulmonary edema were given dexamethasone, sildenafil, or acetazolamide in addition to oxygen, nifedipine, and descent. This finding may be related to perceived severity of illness and evacuation limitations. Although no adverse effects were observed, the use of multiple medications is not supported by current evidence and should not be widely adopted without further study.

Elsevier

Treatment of High Altitude Pulmonary Edema at 4240 m in Nepal

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.

High Altitude Medicine & Biology