Nifedipine for the Treatment of High Altitude Pulmonary Edema Rajesh Deshwal, MD, FHM; Mohd Iqbal, MD; Sidhant Basnet, MBBS From the Department of Medicine, Military Hospital, Gangtok, Sikkim, India (Drs Deshwal, Iqbal, and Basnet). Objective: The purpose of this study was to assess the risk factors, patient profile, clinical features, and oral nifedipine as a treatment option for a series of 110 patients with high altitude pulmonary edema (HAPE) in a military hospital in India. Search. Keeping the patient warm will minimize cold-induced sympathetic contribution to HAPE. Early detection, early diagnosis, and early treatment are essential to maintain the safety of people who ascend to high altitude, such as construction workers and tourists. High-altitude pulmonary edema is a life-threatening form of non-cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above 2,500 meters. If you're climbing or traveling at high altitudes and have mild symptoms of HAPE, descend 1,000 to 3,000 feet (about 300 to 1,000 meters) as quickly as you can, within reason. Mounier R, Amonchot A, Caillot N, et al. High-altitude pulmonary edema (HAPE) is a life-threatening disease of high altitude that often affects nonacclimatized apparently healthy individuals who rapidly ascend to high altitude. Deshwal R, Iqbal M, Basnet S. Nifedipine for the treatment of high altitude pulmonary edema. In high-altitude pulmonary edema (HAPE), it's theorized that vessels in the lungs constrict, causing increased pressure. [Medline]. Clinical observations suggest acetazolamide may prevent reentry HAPE, a disorder seen in individuals who reside at high altitude, travel to lower elevation, and then develop HAPE upon rapid return to their homes. Eur J Med Res. Pandey P, Lohani B, Murphy H. Pulmonary embolism masquerading as high altitude pulmonary edema at high altitude. In one study, 11 patients at 4240 m altitude in Pheriche, Nepal, were treated for HAPE with bed rest, oxygen, nifedipine, and acetazolamide. Diseases & Conditions, 2003
[ 2, 3] The risk of HAPE can be reduced by sleeping one night at an intermediate altitude. 179 (2-3):294-9. High altitude pulmonary edema is an easily treatable, though potentially fatal, syndrome of the acute mountain illnesses. 2007 Summer. Medical students demonstrate the use of a portable hyperbaric chamber. Ann Intern Med. in widespread clinical practice. 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. 2017 Jan. 26 (143):[Medline]. examined 51 healthy controls and 41 cases of HAPE patients and. Patients should be closely observed for rebound symptoms after hyperbaric treatments. Gallegos A. COVID-19 daily: Ventilator protocols questioned, physician rights. Altitude-related illnesses range from acute mountain sickness, which is common and usually mild, to life-threatening high-altitude pulmonary edema and high-altitude cerebral edema. High altitude pulmonary edema (HAPE) is a non-cardiogenic edema which afflicts susceptible persons who ascend to altitudes above 2500 meters and remain there for 24 to 48 h or longer. As a group of physicians who have in some cases cared for patients with COVID-19 and in all … Available at https://www.medscape.com/viewarticle/928236. Descend if the symptoms become worse while resting at the same altitude. A physiologic (simulated) descent of approximately 2000 m may be achieved in a few minutes. [Medline]. 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. Laurie A Ward, MD, FACP Director of Population Health, Wyckoff Heights Medical Center [Medline]. | Microrna. Prevention and treatment of high altitude pulmonary edema by a calcium channel blocker. Two participants who received tadalafil developed severe acute mountain sickness upon arrival at 4559 m and withdrew from the study; they did not have HAPE at that time. It commonly affects recreational hikers and skiers, but it can also be observed in well-conditioned athletes. It has been shown to blunt hypoxic pulmonary vasoconstriction but there are no data specifically supporting a role in HAPE prevention. 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. In normal lungs, air sacs (alveoli) take in oxygen and release carbon dioxide. Mounier R, Amonchot A, Caillot N, et al. Prophylactic low-dose acetazolamide reduces the incidence and severity of acute mountain sickness. [Full Text]. Causes of Pulmonary Edema Cardiogenic Pulmonary Edema. High-altitude pulmonary edema (HAPE). HAPE incidence ranges from an estimated 0.01% to 15.5%. Dexamethasone is in widespread use for the prevention of high altitude pulmonary edema. Immediate descent or supplemental oxygen and nifedipine or sildenafil are recommended until descent is possible. Objective.—The purpose of this study was to assess the risk factors, patient profile, clinical features, and oral nifedipine as a treatment … High-altitude pulmonary edema (HAPE) is a life-threatening noncardiogenic form of pulmonary edema (PE) that develops in nonacclimatized persons after rapid ascent to altitudes above 2000 to 3000 m. HAPE is primarily a pulmonary disorder, whereas acute mountain sickness (AMS) and the much less frequent high-altitude cerebral edema, are neurologic disorders. High-altitude pulmonary edema, which is the lungs' response to an increase in altitude, may occur with or without other symptoms of altitude illness. 2010 May-Jun. Worcester S. Is protocol-driven COVID-19 ventilation doing more harm than good?. It is a non-cardiogenic pulmonary edema which typically occurs in rapidly climbing unacclimatized lowlanders usually within 2-4 days of ascent above 2500-3000m. High altitudes cause the lungs compensate by filling with … #science ; References. 362571-overview
[Full Text]. The cardinal symptom of AMS is headache that occurs with an increase in altitude. [Medline]. Jones BE, Stokes S, McKenzie S, Nilles E, Stoddard GJ. 131(4):1013-8. The medications were administered during ascent and at a stay at 4559 m altitude. Later, dyspnoea occurs at rest. Drugs are not as effective as descent from altitude and oxygen in the treatment of high-altitude pulmonary edema (HAPE). Eight of 9 participants who received placebo, 7 of 10 who received tadalafil, and 3 of 10 who received dexamethasone had acute mountain sickness (P = 1.0 for tadalafil vs placebo; P = .020 for dexamethasone vs placebo). J Appl Physiol. Courtesy of High Altitude Medicine & Biology (PMID: 27768392, online at https://www.liebertpub.com/doi/full/10.1089/ham.2016.0008). [Medline]. 2019 Dec. 30 (4S):S3-S18. [Medline]. A randomized, double-blinded, placebo-controlled study showed that adults with previous HAPE who received prophylactic tadalafil (10 mg) or dexamethasone (8 mg) had significantly less HAPE compared with those who received placebo twice daily. Zafren K. Gamow bag for high-altitude cerebral oedema. 2007 Summer. 2005 Nov 16. Rohit Goyal, MD Fellow, Division of Pulmonary Medicine, Lenox Hill Hospital, New York University School of Medicine The patient received bed rest, supplemental oxygen, and oral sustained-release nifedipine 20 mg twice daily. Nifedipine for the Treatment of High Altitude Pulmonary Edema Rajesh Deshwal, MD, FHM; Mohd Iqbal, MD; Sidhant Basnet, MBBS From the Department of Medicine, Military Hospital, Gangtok, Sikkim, India (Drs Deshwal, Iqbal, and Basnet). Available at https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/altitude-illness. Travel to high altitude thus laces individuals at risk for a variety of complications related to the low ambient oxygen conditions. Wilderness Environ Med 2004; 15:198. Far from describing all the physiological and pathological responses of the organism, in this review, the authors expose the state of the art in the knowledge of the responsiveness of the pulmonary circle to the acute or chronic hypoxic condition, its possible progression to the pulmonary arterial hypertension, the latter being more appropriately named High-Altitude Pulmonary … [Guideline] US Food and Drug Administration. [4]. It is the most common cause of death resulting from the exposure to high altitude. Acetazolamide and dexamethasone have been shown to be effective agents for prophylaxis against high-altitude illness. [Medline]. High altitude pulmonary edema (HAPE) is a noncardiogenic pulmonary edema which typically occurs in lowlanders who ascend rapidly to altitudes greater than 2500-3000 m. Early symptoms of HAPE include a nonproductive cough, dyspnoea on exertion and reduced exercise performance. 8th ed. Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, Zafren K, Hackett PH; Wilderness Medical Society. Cardiovasc Res. 250.468.7685 [email protected] Health Testing. 23 (1):7-10. Mir Mustafa Ali Deccan College of Medical Sciences, Owaisi Hospital and Research Center, Princess Esra HospitalDisclosure: Nothing to disclose. Cerebral edema, or brain swelling, is a potentially life-threatening condition. See also the Guidelines section for prevention guidance from the Wilderness Medical Society April 2020; Accessed: April 7, 2020. 2020 Mar 27. High altitude pulmonary edema (HAPE) Envenomation, such as with the venom of Atrax robustus; Signs and symptoms. 2000 Mar. Respir Physiol Neurobiol. Prog Cardiovasc Dis. Advances in the prevention and treatment of high altitude illness. 2016 Dec. 17 (4):353-8. Fagenholz PJ, Gutman JA, Murray AF, Harris NS. 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. However, cases have also been reported between 1,500–2,500 metres or 4,900–8,200 feet in more vulnerable subjects. It is a clinical diagnosis characterized by fatigue, dyspnea, and dry cough with exertion. Chest. If you log out, you will be required to enter your username and password the next time you visit. If evacuation to a lower altitude is unsafe or impossible (e.g., severe weather) and supplemental oxygen is unavailable, … Courtesy of Extreme Physiology & Medicine (PMID: 24636661, online at https://extremephysiolmed.biomedcentral.com/track/pdf/10.1186/2046-7648-3-6). What might seem usual is not the same for anyone with pulmonary edema.Struggling to get enough air and frequently becoming short o. Qazi Qaisar Afzal, MD Clinical Instructor, Department of Medicine, State University of New York at Stony Brook The effects of a graded increase in chronic hypoxia exposure duration on healthy rats at high-altitude. Ther Umsch. 2008 Winter;19(4):293-303. doi: 10.1580/07-WEME-REV-173.1. Correlation between single nucleotide polymorphisms in hypoxia-related genes and susceptibility to acute high-altitude pulmonary edema. Please confirm that you would like to log out of Medscape. Sildenafil is used as a preventive treatment for altitude-induced pulmonary edema and pulmonary hypertension, [22] [23] the mechanism of action is via phosphodiesterase inhibition which raises cGMP, resulting in pulmonary arterial vasodilation and inhibition of smooth muscle cell … 2006 Oct 3. [Medline]. This condition is life-threatening. [27] Dexamethasone prophylaxis may also reduce the incidence of acute mountain sickness in these adults. Leshem E, Pandey P, Shlim DR, Hiramatsu K, Sidi Y, Schwartz E. Clinical features of patients with severe altitude illness in Nepal. 131 (6):582-90. Altitude-related illnesses range from acute mountain sickness, which is common and usually mild, to life-threatening high-altitude pulmonary edema and high-altitude cerebral edema. Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness. Clinical Review, You are being redirected to
Eldridge MW, Braun RK, Yoneda KY, Walby WF. Giesenhagen AM(1), Ivy DD(1), Brinton JT(2), Meier MR(2), Weinman JP(3), Liptzin DR(4). 2015 Feb 10. Treatment includes: Descent to lower elevation ; Oxygen supplementation; Nifedipine; Caused by sympathetic stimulation from hypobaric hypoxic exposure, causing uneven pulmonary vasculature constriction and when paired with a leaky endothelium, pulmonary edema. Educate travelers with the following three Centers for Disease Control and Prevention (CDC) principles to prevent death or serious consquences from altitude illness Available at https://www.medscape.com/viewarticle/928160. Antibiotics may be given if a fever is present and pneumonia is possible. High Alt Med Biol. Yanamandra U, Nair V, Singh S, Gupta A, et al. Pulmonary embolism masquerading as HAPE. 1991 Oct 31. Pulmonary arterial systolic pressure and susceptibility to high altitude pulmonary edema. HAPE is one of the leading causes of death in high altitudes with rates as high as 6% for climbers who rapidly ascend in the Alps. Prog Cardiovasc Dis. 325 (18):1284-9. High-altitude pulmonary edema (HAPE). Oxygen saturation was improved at discharge (84% ± 1.7%) compared with admission (59% ± 11%), as was the 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. Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Altitude Pulmonary Edema in Children: A Single Referral Center Evaluation. 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. Cai W, Liu Z, Li G, Xiao P, Lv Q, Gong Y, Fan H, Hou S, Ding H. Int J Clin Exp Pathol. Furthermore, decreased fluid clearance from the alveoli may contribute to this noncardiogenic pulmonary edema. Here's the symptoms, causes, and six treatment methods of cerebral edema. 2008 Sep-Oct. 15(5):315-22. OBSERVATIONS: There is no indication for HAPE prophylaxis in altitude naive children. HAPE is a form of noncardiogenic pulmonary edema that occurs secondary to hypoxia. High altitude pulmonary edema (HAPE). Fagenholz PJ(1), Gutman JA, Murray AF, Harris NS. Plain chest x-ray (radiograph) of a patient diagnosed with HAPE. High-altitude pulmonary edema (HAPE) is a life-threatening disease of high altitude that often affects nonacclimatized apparently healthy individuals who rapidly ascend to high altitude. You won't believe what this test reveals! [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). High Alt Med Biol. NLM April 6, 2020; Accessed: April 6, 2020. High-Altitude Pulmonary Edema HAPE can occur by itself or in conjunction with AMS and HACE; incidence is 1 per 10,000 skiers in Colorado and up to 1 per 100 climbers at more than 14,000 ft (4,270 m). 2007 Summer. Are Diabetes, CVD Associated With Worse COVID-19 Prognosis? HAPE may lead to shortness of breath, coughing, rapid heartbeat, and decreased oxygen levels as a result of pressure from constricted pulmonary capillaries. High Alt Med Biol. 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. Eur Respir Rev. Philadelphia, PA: Elsevier; 2017 May. Alam P, Pasha MA, Saini N. microRNAs: an apparent switch for high-altitude pulmonary edema. Interventions for preventing high altitude illness: Part 3. Stress Doppler echocardiography for identification of susceptibility to high altitude pulmonary edema. Available at https://www.fda.gov/media/136449/download. Maggiorini M. Prevention and treatment of high-altitude pulmonary edema. Wilkins MR, Ghofrani HA, Weissmann N, Aldashev A, Zhao L. Pathophysiology and treatment of high-altitude pulmonary vascular disease. However, variation in the pulmonary vascular response to hypoxia is well recognized, both between and within species, 16,31,54,55 and in humans the magnitude of HPV can vary ≈5-fold among individuals. [Medline]. Incidence varies with the rate of ascent and the altitude, while contributing factors include exertion and perhaps cold. [Medline]. Oxygen, if available, should be provided. In medical facilities, high-flow supplemental oxygen while at rest and sitting in an upright position should be initiated immediately during the initial assessment of the patient. Wilderness Environ Med. Prog Cardiovasc Dis. Pulmonary … Acetazolamide, Nifedipine and Phosphodiesterase Inhibitors: Rationale for Their Utilization as Adjunctive Countermeasures in the Treatment of Coronavirus Disease 2019 (COVID-19). 2019 Jun 1;12(6):1975-1991. eCollection 2019. 2006 Mar. 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). doi: 10.7759/cureus.7343. Acetazolamide, which appears to hasten acclimatization, is considered the drug of choice because of a low incidence of significant adverse effects. J Travel Med. High Altitude Pulmonary Edema (HAPE) should be at the forefront of every mountaineer’s mind. The most severe form of altitude sickness, high-altitude cerebral edema (HACE), results when a buildup of fluid causes swelling of the brain. [Medline]. If progressive high altitude acclimatization would not be possible, prophylaxis with nifedipine or tadalafil for long sojourns at high altitude or dexamethasone for a … eCollection 2019 Oct. Molano Franco D, Nieto Estrada VH, Gonzalez Garay AG, Martí-Carvajal AJ, Arevalo-Rodriguez I. Cochrane Database Syst Rev. Repeat chest x-ray after 2 days showing rapid resolution of the pulmonary edema in the same Himalayan trekker discussed in the previous image. 2020 Mar 28. Info on the very dangerous form of mountain sickness - high-altitude pulmonary edema. This causes fluid to leak from the blood vessels to the lung tissues and eventually into the air sacs. High-altitude travel & altitude illness. Hartmann G, Tschop M, Fischer R, et al. 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). 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 High-altitude pulmonary edema. High-altitude pulmonary edema (HAPE) is a life-threatening noncardiogenic form of pulmonary edema (PE) that afflicts susceptible persons after rapid ascent to high altitude above 2500 m. Its pathogenesis is related to increased sympathetic tone, exaggerated hypoxic pulmonary vasoconstriction, uneven … Admission to a hospital is warranted for significant arterial desaturation and clinical deterioration despite outpatient management of HAPE. van Patot MC, Leadbetter G 3rd, Keyes LE, Maakestad KM, Olson S, Hackett PH. 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