2020 Apr 15;101(8):505-507. Ann Intern Med. S… HAPE is characterized by reduced exercise tolerance, exertional dyspnea, and cough, followed by dyspnea at rest, cyanosis, and productive cough with pink frothy sputum. [Medline]. Nifedipine or other pulmonary vasodilators may be used to treat concurrent HAPE and HACE, but avoid lowering mean arterial pressure, as this may decrease cerebral perfusion pressure and thereby increase the risk for cerebral ischemia. 2011. The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Bärtsch P, Maggiorini M, Ritter M, et al. In: Weiss EA, Sward DG, eds. Maggiorini M. Prevention and treatment of high-altitude pulmonary edema. [Medline]. 2015 Apr. / afp Gallegos A. COVID-19 daily: Ventilator protocols questioned, physician rights. 35(4):980-7. 12(3):246-52. [Medline]. High-Altitude Pulmonary Edema: Diagnosis, Prevention, and Treatment Andre Pennardt, MD, FACEP, FAWM Abstract High-altitude pulmonary edema (HAPE) is a lethal, noncardiogenic form of pulmonary edema that afflicts susceptible individuals after rapid as-cent to high altitude above 2,500 m. Prevention of HAPE is achieved most effectively by gradual ascent allowing time for … / Vol. [Medline]. Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine Acetazolamide is used in the prevention of HAPE. [Medline]. This article covers its milder form, Acute Mountain Sickness (AMS), as well as the more serious conditions of HACE (High-Altitude Cerebral Edema) and HAPE (High-Altitude Pulmonary Edema). 55, 84–88, 91–95 Some individuals, however, can [Full Text]. People without a history of AMS who do not sleep above 9,200 ft (2,800 m) are at low risk of AMS. These agents have profound and varied metabolic effects. • Gradually increasing sleeping altitude is the best way to prevent altitude illness. [Guideline] US Food and Drug Administration. [Guideline] Hackett PH, Shlim DR. CDC Yellow Book 2018. Eur Respir Rev. [Full Text]. Fagenholz PJ, Gutman JA, Murray AF, Harris NS. 2015 Feb 10. Jensen JD, Vincent AL. Prevention of high-altitude pulmonary edema by nifedipine. • Acetazolamide and dexamethasone can be used to prevent acute mountain sickness and high altitude cerebral edema, but only acetazolamide aids in acclimatization. High-Altitude Pulmonary Edema. 2013 Mar. High-altitude … You should also: avoid flying directly to areas of high altitude, if possible; take 2 to 3 days to get used to high altitudes before going above 2,500m Pandey P, Lohani B, Murphy H. Pulmonary embolism masquerading as high altitude pulmonary edema at high altitude. 100(3):972-80. The patient was a middle-aged woman trekker who was emergency air-lifted from an altitude of 4410 m in the Nepal Himalayas to 1300 m in Kathamandu. J Travel Med. Medscape Education. [2, 3] Furthermore, WMS indicates there is no established role for acetazolamide, beta-agonists, diuretics, or dexamethasone in the treatment of HAPE, although dexamethasone should be considered where there is concern for concomitant high-altitude cerebral edema (HACE). Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. Am Fam Physician. Genet Mol Res. 2015 Nov 3. [Medline]. [Medline]. It usually takes a few days for your body to get used to a change in altitude. 8(2):139-46. 2010 May-Jun. The incidence of High Altitude Pulmonary Edema (HAPE) among unacclimatized travelers to altitude is largely dependent on genetic susceptibility, the rate of ascent, and the final altitude achieved. Cytokine. Maggiorini M, Brunner-La Rocca HP, Peth S, et al. Gregory Tino, MD Director of Pulmonary Outpatient Practices, Associate Professor, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Medical Center and Hospital April 5, 2020; Accessed: April 6, 2020. High altitude illness (HAI) is a spectrum of conditions characterized by the nausea, vomiting, and sleep disturbances typical of acute mountain sickness (AMS), the ataxia and eventual coma seen in high altitude cerebral edema (HACE), and the cough, dyspnea, and eventual death typical of high altitude pulmonary edema (HAPE). Author disclosure: No relevant financial affiliations. Galcanezumab (Emgality) for Migraine and Cluster Headaches. 2000 Mar 15. a For individuals ascending to and remaining at a given elevation, after arrival at the target elevation, the medication should be continued for 2 d in Previous: Galcanezumab (Emgality) for Migraine and Cluster Headaches, Home Nifedipine, by reducing pulmonary arterial pressure, may be effective in treating HAPE. High Altitude Pulmonary Edema (HAPE) ... you will need supplemental oxygen and may need medications, as well as moving to a lower altitude. In high-altitude pulmonary edema (HAPE), it's theorized that vessels in the lungs constrict, causing increased pressure. Courtesy of High Altitude Medicine & Biology (PMID: 27768392, online at https://www.liebertpub.com/doi/full/10.1089/ham.2016.0008). Pollard AJ, Murdoch DR. afpserv@aafp.org for copyright questions and/or permission requests. Samia Qazi, MD is a member of the following medical societies: American College of Physicians-American Society of Internal MedicineDisclosure: Nothing to disclose. AMS,acute mountain sickness; HACE, high altitude cerebraledema; IM, intramuscularly; ER, extendedrelease;HAPE, highaltitude pulmonary edema. Symptoms may include headaches, vomiting, tiredness, trouble sleeping, and dizziness. If not appropriately treated, AMS can progress to life-threatening HACE or HAPE, which can present together or separately. 209:33-8. HAPE Prevention and Treatment Guidelines (WMS, CDC), FDA Policy for Face Masks, Face Shields, and Respirators in COVID-19 (2020), COVID-19–Related Airway Management Clinical Practice Guidelines (SIAARTI/EAMS, 2020), COVID-19 Ventilation Clinical Practice Guidelines (ESICM, 2020), https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/altitude-illness, https://www.medscape.com/viewarticle/928160, https://www.medscape.com/viewarticle/928236, https://www.fda.gov/media/136449/download, American College of Physicians-American Society of Internal Medicine. This causes fluid to leak from the blood vessels to the lung tissues and eventually into the air sacs. Scherrer U, Rexhaj E, Jayet PY, Allemann Y, Sartori C. New insights in the pathogenesis of high-altitude pulmonary edema. PDE-5-esterase inhibitors, like tadalafil at 10 mg by mouth twice a day can also be used. ... C Sartori, Y Allemann, H Duplain, et al.Salmeterol for the prevention of high-altitude pulmonary edema. Qazi Qaisar Afzal, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Medical Society of the State of New YorkDisclosure: Nothing to disclose. 1631-1636. [Full Text]. 2006 Oct 3. [Medline]. Wilderness Environ Med. Its mechanism is via inhibition of the carbonic anhydrase enzyme which counteracts the respiratory alkalosis which occurs during ascent to altitude. Prog Cardiovasc Dis. Emergency Medicine Clinics of North America: Wilderness and Environmental Medicine. Climbers with a previous history of HAPE, who ascent rapidly above 4500m have a 60% chance of illness recurrence. In normal lungs, air sacs (alveoli) take in oxygen and release carbon dioxide. [Full Text]. / Journals Philadelphia, PA: Elsevier; 2017 May. The Wilderness Medical Society (WMS) advises that diuretics or acetazolamide should not be used for treatment of HAPE, and it makes no recommendation regarding beta-agonists or dexamethasone for HAPE treatment due to insufficient/lack of data. Acute altitude illness comprises acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). Korzeniewski K, Nitsch-Osuch A, Guzek A, Juszczak D. High altitude pulmonary edema in mountain climbers. High Alt Med Biol. Mir Mustafa Ali Deccan College of Medical Sciences, Owaisi Hospital and Research Center, Princess Esra HospitalDisclosure: Nothing to disclose. [29] However, in two separate studies, nifedipine did not outperform placebo or oxygen alone. Axial computed tomography (CT) pulmonary angiogram showing thrombi as filling defects in the right main pulmonary artery (right arrow) extending into its branch and in the distal left pulmonary artery (left arrow) with extension into its superior branch. J Appl Physiol. The Wilderness Medical Society does not use specific altitude thresholds for diagnosis. Fischer R, Lang SM, Bergner A, Huber RM. The Centers for Disease Control and Prevention (CDC) strongly recommends acetazolamide prophylaxis in all individuals with a prior history of HAPE or HACE, as well as with the following Phosphodiesterase type 5 inhibitors in the treatment and prevention of high altitude pulmonary edema. See the CME Quiz Questions. 2020 Mar 28. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Plain chest x-ray (radiograph) of a patient diagnosed with HAPE. They suppress inflammation and the immune response. The medication is effective in preventing acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). [2, 3]. High-altitude pulmonary edema (HAPE) is a life-threatening, noncardiogenic form of pulmonary edema afflicting certain individuals after rapid ascent to high altitude above 2,500 m (approximately 8,200 ft). 2007 Summer. High Alt Med Biol. High-altitude pulmonary edema responds best when the person descends from their current altitude. 2017 Jan. 26 (143):[Medline]. 5:15126. Anaesthesia. Acetazolamide promotes renal excretion of bicarbonate, which stimulates respiration. [Full Text]. Pulm Med. Advances in the prevention and treatment of high altitude illness. Nifedipine is used in HAPE for pulmonary vasodilation. Rohit Goyal, MD is a member of the following medical societies: American College of Chest Physicians, American Medical Association, American Thoracic SocietyDisclosure: Nothing to disclose. Bartsch P, Maggiorini M, Ritter M, Noti C, Vock P, Oelz O. High-altitude pulmonary edema (HAPE). 1991 Oct 31. Courtesy of Extreme Physiology & Medicine (PMID: 24636661, online at https://extremephysiolmed.biomedcentral.com/track/pdf/10.1186/2046-7648-3-6). Available at https://www.medscape.com/viewarticle/928236. 2008 Winter. High-altitude pulmonary edema (HAPE) is a lethal, noncardiogenic form of pulmonary edema that afflicts susceptible individuals after rapid as-cent to high altitude above 2,500 m. Prevention of HAPE is achieved most effectively by gradual ascent allowing time for proper acclimatiza-tion. 43. Wilderness Environ Med. Oxygen, if available, should be provided. Laurie A Ward, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology, National Kidney FoundationDisclosure: Nothing to disclose. / [Medline]. Centers for Disease Control and Prevention. High Alt Med Biol. 179 (2-3):294-9. Prophylactic low-dose acetazolamide reduces the incidence and severity of acute mountain sickness. Copyright © 2020 American Academy of Family Physicians. The recommended regimen for adults with HACE is an initial 8-mg dose given orally, intravenously, or intramuscularly, then 4 mg every six hours until symptoms resolve. The patient received bed rest, supplemental oxygen, and oral sustained-release nifedipine 20 mg twice daily. Prevention and treatment of high altitude pulmonary edema (HAPE) February 2020; Journal of Education, Health and Sport 10(2):114; DOI: 10.12775/JEHS.2020.10.02.015 Want to use this article elsewhere? All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. Ann Intern Med. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Prevention of high-altitude pulmonary edema by nifedipine. 2005 Nov 16. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. High altitude increases circulating interleukin-6, interleukin-1 receptor antagonist and C-reactive protein. [Guideline] Sorbello M, El-Boghdadly K, Di Giacinto I, et al, for the Societa Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) Airway Research Group, The European Airway Management Society. • The most important treatment for altitude illness is descent of 1,000 to 3,300 ft, with supplemental oxygen if available. Because the risk of acute altitude illness depends on acclimatization, sleeping altitude is more important than altitude reached while awake. Instead, spend a few days at 8,000–9,000 feet before proceeding to a higher altitude to give your body time to adjust to the low oxygen levels. [Medline]. High altitude pulmonary edema (HAPE). This website also contains material copyrighted by 3rd parties. The High Altitude Medicine Handbook. Nifedipine , a medication for high blood pressure, has been shown to be beneficial for high-altitude pulmonary edema. Unacclimatized people are at high risk of acute altitude illness when ascending above 8,200 ft (2,500 m), but AMS can occur as low as 6,500 ft (2,000 m). Contact Regardless of AMS history, all people are at high risk of AMS if they: (1) make a one-day ascent to a sleeping altitude above 11,500 ft (3,500 m); (2) make extremely rapid ascents (e.g., climbing Mt. 1,5 However, for ascents greater than 5500m the … Burlington, MA: Jones & Bartlett Learning; 2021. ch 38. Once you are above 9,000 feet, increase your sleeping altitude b… The recommendation for its use is strongest for individuals with a history of HAPE. Alam P, Pasha MA, Saini N. microRNAs: an apparent switch for high-altitude pulmonary edema. Chest X-ray. A chest X-ray will likely … High-altitude pulmonary edema (HAPE). Three plasma metabolite signatures for diagnosing high altitude pulmonary edema. Stress Doppler echocardiography for identification of susceptibility to high altitude pulmonary edema. Mir Omar Ali, MD Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital, New York University Pulmonary arterial systolic pressure and susceptibility to high altitude pulmonary edema. 8th ed. Courtesy of Extreme Physiology & Medicine (PMID: 24636661, online at https://extremephysiolmed.biomedcentral.com/track/pdf/10.1186/2046-7648-3-6). Although HACE presents with similar symptoms as AMS, the cerebral edema can lead to ataxia, confusion, or altered mental status. Mounier R, Amonchot A, Caillot N, et al. Bärtsch P, Swenson ER, Maggiorini M. Update: High altitude pulmonary edema. Microrna. [Medline]. Monitoring of expiratory flow rates and lung volumes during a high altitude expedition. Maggiorini M, Brunner-La Rocca HP, Peth S, et al. HACE is typically encountered at higher elevations unless presenting with HAPE. It is not used in the treatment of this condition. for: Medscape. Sign up for the free AFP email table of contents. Nancy Caroline's Emergency Care in the Streets Advantage Package (Canadian Edition). Respir Physiol Neurobiol. Davis C, Hackett. 101/No. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a … It is not used in the treatment of this condition. 14 (3):11562-72. 2012 Mar. 9 (4):289-93. Prevention. Leshem E, Pandey P, Shlim DR, Hiramatsu K, Sidi Y, Schwartz E. Clinical features of patients with severe altitude illness in Nepal. Rohit Goyal, MD Fellow, Division of Pulmonary Medicine, Lenox Hill Hospital, New York University School of Medicine The aim of this article was to present the relevant details concerning epidemiology, pathophysiology, clinical symptoms, prevention, and treatment of high altitude pulmonary edema among climbers in the mountain environment. Available at https://www.medscape.com/viewarticle/928160. The best way to prevent getting altitude sickness is to travel to altitudes above 2,500m slowly. [2, 3] If supplemental oxygen is not available, initiate dexamethasone in addition to medications for HAPE in those with mental status changes and/or suspected concurrent HACE. Yanamandra U, Nair V, Singh S, Gupta A, et al. It often improves SaO2 modestly within a few minutes. People with a history of AMS who make a one-day ascent to a sleeping altitude above 9,200 ft have a high risk of developing AMS. 2019 Dec. 30 (4S):S3-S18. HAPE is the most common cause of death related to high altitude. All rights Reserved. Treatment of high altitude pulmonary edema at 4240 m in Nepal. Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Thomas SH, Harris NS. 2016 Dec. 17 (4):353-8. Wilderness Environ Med. Prog Cardiovasc Dis. encoded search term (High-Altitude Pulmonary Edema (HAPE)) and High-Altitude Pulmonary Edema (HAPE), Acute Respiratory Distress Syndrome (ARDS), Acute Respiratory Distress Syndrome (ARDS) Imaging, Pediatric Acute Respiratory Distress Syndrome, Fast Five Quiz: Acute Respiratory Distress Syndrome (ARDS), Symptoms and Management of Coronavirus Disease 2019 (COVID-19) FAQ, Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures, Lower-PEEP Strategy Promising in Critically Ill Patients Without Respiratory Distress, Prognostic Factors for 30-Day Mortality in Critically Ill Patients With Coronavirus Disease 2019, Pulse Oximeters Miss Low Oxygen Levels Nearly Three Times More Often in Blacks Than Whites, Score Predicts Risk for Ventilation in COVID-19 Patients, Intake of Vitamins A, E and D Tied to Respiratory Health, Stop Prescribing Nocturnal Oxygen to Patients With COPD, Asthma Clinical Practice Guidelines (JSA, 2020), Oxygen Use More Than Expected During Aero-Medevac of COVID Patients. Effects of altitude and exercise on pulmonary capillary integrity: evidence for subclinical high-altitude pulmonary edema. 2020 Jan. [Medline]. 2000 Mar. To see the full article, log in or purchase access. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. High-altitude pulmonary edema (HAPE) is a potentially life-threatening condition that typically occurs in young, otherwise healthy people after rapid ascent to an altitude of 2500 m or higher. Deshwal R, Iqbal M, Basnet S. Nifedipine for the treatment of high altitude pulmonary edema. Repeat chest x-ray after 2 days showing rapid resolution of the pulmonary edema in the same Himalayan trekker discussed in the previous image. Suggested medications for high-altitude travelers are listed in Table 42.2. 2007 Apr. Management of high altitude pulmonary edema in the Himalaya: a review of 56 cases presenting at Pheriche medical aid post (4240 m). Qazi Qaisar Afzal, MD Clinical Instructor, Department of Medicine, State University of New York at Stony Brook View Record in Scopus Google Scholar. 52 (6):485-92. High-altitude pulmonary edema (HAPE). Practice Guidelines: Acute Altitude Illness: Updated Prevention and Treatment Guidelines from the Wilderness Medical Society. Zhou Q. 2006 Mar. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Nifedipine, for example, can be administered at a rate of 60mg of a timed-release preparation daily, in 2 or 3 divided doses. High-altitude pulmonary edema (HAPE) is a lethal, noncardiogenic form of pulmonary edema that afflicts susceptible individuals after rapid ascent to high altitude above 2,500 m. Prevention of HAPE is achieved most effectively by gradual ascent allowing time for proper acclimatization. Immediate, unlimited access to all AFP content. Antibiotics may be given if a fever is present and pneumonia is possible. [Medline]. Courtesy of Wikipedia (https://en.wikipedia.org/wiki/File:Chest_XR_of_HAPE.png). Jones BE, Stokes S, McKenzie S, Nilles E, Stoddard GJ. 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. [Medline]. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). High-altitude pulmonary edema (HAPE). Kilimanjaro [19,341 ft (5,895 m)] in fewer than seven days); or (3) ascend to a sleeping altitude above 9,800 ft, then sleep more than 1,600 ft above the previous night's altitude without allowing a day off to acclimatize. J Am Coll Cardiol. Mir Omar Ali, MD is a member of the following medical societies: American College of Physicians, Society of Critical Care MedicineDisclosure: Nothing to disclose. As more people enjoy the outdoors, high-altitude illness is increasingly becoming a problem that family physicians across the country must treat. 325 (18):1284-9. Choose a single article, issue, or full-access subscription. Drugs are not as effective as descent from altitude and oxygen in the treatment of high-altitude pulmonary edema (HAPE). People can live comfortably at moderately high altitudes, but the body must make some adjustments, and this takes time. Environmental emergencies. 2016 Dec. 17 (4):294-9. If you log out, you will be required to enter your username and password the next time you visit. Abingdon, UK: Radcliffe Medical Press; 2003. N Engl J Med, 346 (21) (2002), pp. 2020 Mar 27. [Full Text]. Staged ascent and preacclimatization to hypoxia also reduce risk. [Medline]. Diseases & Conditions, 2003 Managing high-altitude pulmonary edema with oxygen alone: results of a randomized controlled trial. 2008 Sep-Oct. 15(5):315-22. Samia Qazi, MD Chief, Division of Primary Care, Nassau University Medical Center; Clinical Assistant Professor of Clinical Medicine, Renaissance School of Medicine at Stony Brook University Do not go from a low altitude to sleeping at higher than 9,000 feet above sea level in one day. 145(7):497-506. Medical Sciences, Owaisi Hospital and Research Center, Princess Esra HospitalDisclosure: Nothing to.! ( Emgality ) for Migraine and Cluster Headaches MD, editor-in-chief P. acute high-altitude pulmonary edema high! And high altitude Medicine & Biology ( PMID: 24636661, online at https: //extremephysiolmed.biomedcentral.com/track/pdf/10.1186/2046-7648-3-6.!, Iqbal M, Brunner-La Rocca HP, Peth S, Nilles E, Jayet PY, Y... If available have a 60 % chance of illness recurrence, Maggiorini M. and! 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