Management of high altitude pulmonary edema in the Himalaya: a review of 56 cases presenting at Pheriche medical aid post (4240 m)
| Autor: | Eric J. Nilles, Gregory J. Stoddard, Suzy Stokes, Suzi McKenzie, Barbara E. Jones |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Nifedipine medicine.medical_treatment Hypertension Pulmonary Vasodilator Agents Altitude Sickness Dexamethasone Piperazines Sildenafil Citrate Article Nepal Oxygen therapy Severity of illness High-altitude pulmonary edema medicine Humans Sulfones Emergency Treatment Altitude sickness Retrospective Studies business.industry Public Health Environmental and Occupational Health Oxygen Inhalation Therapy Hypoxia (medical) medicine.disease Pulmonary hypertension Mountaineering Acetazolamide Treatment Outcome Purines Anesthesia Emergency Medicine Female Seasons medicine.symptom business High-altitude cerebral edema medicine.drug |
| Zdroj: | Wildernessenvironmental medicine. 24(1) |
| ISSN: | 1545-1534 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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