High-altitude pulmonary edema (HAPE) is a life-threatening noncardiogenic form of pulmonary ede-ma (PE) that afflicts susceptible persons after rapid ascent to high altitude above 2500 m. Its patho-genesis is related to increased sympathetic tone, exaggerated hypoxic pulmonary vasoconstriction, [Guideline] Alhazzani W, Moller MH, Arabi YM, et al. 2020 Mar 28. Regardless of AMS history, people who allow at least two days to ascend to a sleeping altitude of 8,200 to 9,800 ft (2,500 to 3,000 m) are at low risk if they sleep no more than 1,600 ft (500 m) above the previous night's altitude and take a day to acclimatize after every increase of 3,300 ft (1,000 m) in sleeping altitude. In high-altitude pulmonary edema (HAPE), it's theorized that vessels in the lungs constrict, causing increased pressure. [4] : Further research is needed before tadalafil or dexamethasone can be recommended over nifedipine for prophylaxis. Circulation. Eur J Med Res. High-altitude pulmonary edema (HAPE). Managing high-altitude pulmonary edema with oxygen alone: results of a randomized controlled trial. Altitude sickness, the mildest form being acute mountain sickness (AMS), is the negative health effect of high altitude, caused by rapid exposure to low amounts of oxygen at high elevation. 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. Choose a single article, issue, or full-access subscription. Practice Guidelines: Acute Altitude Illness: Updated Prevention and Treatment Guidelines from the Wilderness Medical Society. Maggiorini M. Prevention and treatment of high-altitude pulmonary edema. The medication is effective in preventing acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). Do not go from a low altitude to sleeping at higher than 9,000 feet above sea level in one day. Medscape Education. 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. [Medline]. 2014 Dec. 25 (4 suppl):S4-14. The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. [Medline]. • The most important treatment for altitude illness is descent of 1,000 to 3,300 ft, with supplemental oxygen if available. Courtesy of Extreme Physiology & Medicine (PMID: 24636661, online at https://extremephysiolmed.biomedcentral.com/track/pdf/10.1186/2046-7648-3-6). Microrna. [Full Text]. [Full Text]. Wilderness Environ Med. [Full Text]. Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Thomas SH, Harris NS. Once you are above 9,000 feet, increase your sleeping altitude b… [Medline]. Immediate, unlimited access to all AFP content. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. 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. 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. 2015 Apr. Environmental emergencies. 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. The best way to prevent getting altitude sickness is to travel to altitudes above 2,500m slowly. 2015 Nov 3. 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 People with a history of AMS who make a one-day ascent to a sleeping altitude of 8,200 to 9,200 ft have a moderate risk of AMS. [Medline]. N Engl J Med. Samia Qazi, MD is a member of the following medical societies: American College of Physicians-American Society of Internal MedicineDisclosure: Nothing to disclose. 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 [Medline]. In those with no prior history of HAPE who ascend to 4500m the incidence is relatively low, ranging from 0.01-0.2%. Maggiorini M, Brunner-La Rocca HP, Peth S, et al. Those without a previous episode who make a one-day ascent to a sleeping altitude above 9,200 ft also have a moderate risk. Pulmonary embolism masquerading as HAPE. 3rd ed. Respir Physiol Neurobiol. 2011:190648. /viewarticle/926097 All people with a history of HACE or HAPE are at high risk of AMS, regardless of sleeping elevation or rate of ascent. N Engl J Med, 346 (21) (2002), pp. Repeat chest x-ray after 2 days showing rapid resolution of the pulmonary edema in the same Himalayan trekker discussed in the previous image. StatPearls [Internet]. This content is owned by the AAFP. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. 2002 Effects of altitude and exercise on pulmonary capillary integrity: evidence for subclinical high-altitude pulmonary edema. 100(3):972-80. 2020 Mar 27. Suggested medications for high-altitude travelers are listed in Table 42.2. It is not used in the treatment of this condition. The Wilderness Medical Society does not use specific altitude thresholds for diagnosis. The patient received bed rest, supplemental oxygen, and oral sustained-release nifedipine 20 mg twice daily. Want to use this article elsewhere? [Full Text]. Treatment of high altitude pulmonary edema at 4240 m in Nepal. Available at https://www.medscape.com/viewarticle/928160. Curr Opin Investig Drugs 2007; 8:226. [Full Text]. The High Altitude Medicine Handbook. Alam P, Pasha MA, Saini N. microRNAs: an apparent switch for high-altitude pulmonary edema. 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 … Diseases & Conditions, 2003 Fischer R, Lang SM, Bergner A, Huber RM. Available at https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/altitude-illness. Antibiotics may be given if a fever is present and pneumonia is possible. Stress Doppler echocardiography for identification of susceptibility to high altitude pulmonary edema. Prevention of high-altitude pulmonary edema by nifedipine. Gallegos A. COVID-19 daily: Ventilator protocols questioned, physician rights. Author disclosure: No relevant financial affiliations. 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). Acetazolamide promotes renal excretion of bicarbonate, which stimulates respiration. [Medline]. This causes fluid to leak from the blood vessels to the lung tissues and eventually into the air sacs. 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 Climbers with a previous history of HAPE, who ascent rapidly above 4500m have a 60% chance of illness recurrence. Bärtsch P, Maggiorini M, Ritter M, et al. April 6, 2020; Accessed: April 6, 2020. 2008 Winter. 2017 Jan. 26 (143):[Medline]. [4] : The CDC recommends the following pharmacologic agents and regimens for HAPE prophylaxis Nifedipine, for example, can be administered at a rate of 60mg of a timed-release preparation daily, in 2 or 3 divided doses. Adv Exp Med Biol 2001; 502:89. Genet Mol Res. 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. Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. High-altitude pulmonary edema (HAPE). Nifedipine , a medication for high blood pressure, has been shown to be beneficial for high-altitude pulmonary edema. [Full Text]. 1 Though uncommon, HAPE is a potentially life … Zhou Q. Enforcement policy for face masks and respirators during the coronavirus disease (COVID-19) public health emergency : guidance for industry and Food and Drug Administration staff. 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. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Cytokine. Maggiorini M, Brunner-La Rocca HP, Peth S, et al. Leshem E, Pandey P, Shlim DR, Hiramatsu K, Sidi Y, Schwartz E. Clinical features of patients with severe altitude illness in Nepal. To see the full article, log in or purchase access. Standardization of methods for early diagnosis and on-site treatment of high-altitude pulmonary edema. Wilderness Environ Med. Management of high altitude pulmonary edema in the Himalaya: a review of 56 cases presenting at Pheriche medical aid post (4240 m). High-altitude travel & altitude illness. Burlington, MA: Jones & Bartlett Learning; 2021. ch 38. 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. Ann Intern Med. Am Fam Physician. Prog Cardiovasc Dis. These agents are helpful in the prevention of HAPE. Mir Omar Ali, MD Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital, New York University 55, 84–88, 91–95 Some individuals, however, can Scherrer U, Rexhaj E, Jayet PY, Allemann Y, Sartori C. New insights in the pathogenesis of high-altitude pulmonary edema. Copyright © 2020 by the American Academy of Family Physicians. Share cases and questions with Physicians on Medscape consult. Prevention. Intensive Care Med. Because the risk of acute altitude illness depends on acclimatization, sleeping altitude is more important than altitude reached while awake. April 2020; Accessed: April 7, 2020. J Travel Med. 2000 Mar 15. afpserv@aafp.org for copyright questions and/or permission requests. 8(April 15, 2020) 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 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 Acetazolamide promotes renal excretion of … The reported incidence of HAPE ranges from an estimated 0.01% of skiers traveling from low altitude to Vail, CO (2,500 m), to 15.5% of Indian soldiers rapidly transported to altitudes of 3,355 and 5,9… 2006 Mar. High altitude pulmonary edema: Known for short as HAPE, the accumulation in the lungs of extravascular fluid (fluid outside of blood vessels) at high altitude, a consequence of rapid altitude ascent, especially when that ascent is accompanied by significant exercise.. HAPE leads to dyspnea (shortness of breath), cough, tachycardia (fast heart rate) and decreased arterial … 2012 Mar. All rights Reserved. [Medline]. S… Available at https://www.fda.gov/media/136449/download. 5:15126. Symptoms may include headaches, vomiting, tiredness, trouble sleeping, and dizziness. [Full Text]. [Medline]. Medical students demonstrate the use of a portable hyperbaric chamber. 2016 Dec. 17 (4):294-9. 24 (1):32-6. / Chest. High-altitude pulmonary edema (HAPE). 8(2):139-46. [Medline]. 14 (3):11562-72. The most studied and preferred medication for prevention of HAPE is nifedipine, a pulmonary vasodilator which prevents the altitude induced pulmonary hypertension. 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. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzAwNzE2LW1lZGljYXRpb24=, History of acute mountain sickness and ascending more than 2,800 m in 1 day, All people ascending to more than 3,500 m in 1 day, All people ascending more than 500 m per day (increase in sleeping elevation) above 3,000 m, without extra days for acclimatization, Oral nifedipine (generally reserved for HAPE-susceptible individuals) - 30 mg sustained-release formulation every 12 hours (same regimen for HAPE treatment). See the CME Quiz Questions. 2000 Mar. / Journals [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). Prophylactic low-dose acetazolamide reduces the incidence and severity of acute mountain sickness. A chest X-ray will likely … Abingdon, UK: Radcliffe Medical Press; 2003. Don't miss a single issue. / Vol. 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. [Medline]. This clinical content conforms to AAFP criteria for continuing medical education (CME). Wilderness Environ Med. 2015 Sep 28. 2013 Mar. 131(4):1013-8. Its mechanism is via inhibition of the carbonic anhydrase enzyme which counteracts the respiratory alkalosis which occurs during ascent to altitude. J Am Coll Cardiol. van Patot MC, Leadbetter G 3rd, Keyes LE, Maakestad KM, Olson S, Hackett PH. 2020 Apr 15;101(8):505-507. 2010 May-Jun. 2006 Oct 3; 145(7):497–506. [Medline]. Oxygen, if available, should be provided. 1991 Oct 31. Hartmann G, Tschop M, Fischer R, et al. [Medline]. High Alt Med Biol. [2, 3]. Yanamandra U, Nair V, Singh S, Gupta A, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). 12(3):246-52. 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. 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. She had continued ascending despite experiencing mild altitude symptoms at Namche (3440 m), with considerably worsened symptoms at Tengboche (3860 m). 8th ed. 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). Acute altitude illness comprises acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). 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. Auerbach PS, Freer L, Tan G, Tschop M, et al this also... Wu LJ G 3rd, Keyes LE, Maakestad KM, Olson S et! 26 ( 143 ): S4-14 2020 ; Accessed: April 6, 2020 ; Accessed April! 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