Treatment of high altitude pulmonary edema at 4240 m in Nepal

High Alt Med Biol. Summer 2007;8(2):139-46. doi: 10.1089/ham.2007.3055.

Abstract

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.

MeSH terms

  • Acetazolamide / administration & dosage
  • Adult
  • Albuterol / administration & dosage
  • Albuterol / analogs & derivatives
  • Altitude Sickness / complications*
  • Altitude*
  • Bed Rest
  • Emergency Treatment / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mountaineering*
  • Nepal
  • Nifedipine / administration & dosage
  • Oxygen Inhalation Therapy / methods*
  • Piperazines / administration & dosage
  • Pulmonary Edema / drug therapy
  • Pulmonary Edema / etiology
  • Pulmonary Edema / therapy*
  • Purines / administration & dosage
  • Salmeterol Xinafoate
  • Sildenafil Citrate
  • Sulfones / administration & dosage
  • Treatment Outcome
  • Vasodilator Agents / administration & dosage*

Substances

  • Piperazines
  • Purines
  • Sulfones
  • Vasodilator Agents
  • Salmeterol Xinafoate
  • Sildenafil Citrate
  • Nifedipine
  • Acetazolamide
  • Albuterol