Acute high-altitude pulmonary edema in Huaraz: an analytical cross-sectional study
DOI:
https://doi.org/10.24265/horizmed.2022.v22n3.07Keywords:
Pulmonary Edema, Altitude, DiagnosisAbstract
Objective: To describe some epidemiological and clinical characteristics of acute high-altitude pulmonary edema (HAPE) observed in a hospital of the highlands of Ancash, located at 3,052 m a.s.l. Materials and methods: A descriptive observational study conducted with 57 patients who attended the emergency service of Hospital Víctor Ramos Guardia – Huaraz between January 1997 and January 2020. All patients fulfilled Lake Louise Criteria and had a chest X-ray. Median and range were used to analyze the information.
Results: Male sex accounted for 91.20 %, ascent HAPE 38.61 % and re-ascent HAPE 61.40 %. Out of all patients, 21.10 % had a history of HAPE, 19.33 % developed a previous respiratory infection, 10.53 % had a concomitant disease, 40.42 % had HAPE during the first quarter of the year and 45 % had been 10 days or less at low altitude. Patients’ clinical presentation included dyspnea at rest, pulmonary crackles, tachypnea, tachycardia and abnormal X-ray in 100 %; productive cough in 96.52 %; chest pain in 92.95 %; headache in 56.11 %; cyanosis in 68.41 %; pink sputum in 42.13 %; fever in 21.13 % and leukocytosis in 60.82 %. The median age was 20 years, respiratory rate 36/min, heart rate 124/min, SBP 100 mmHg, DBP 60 mmHg, temperature 37.2 °C, HGB 17.3 g/dl, HCT 53 %, WBC 12,500/mm3, radiographic resolution of the edema in 48 hours. There were no deaths. Conclusions: The factors that influence HAPE and its determinants are altitude, rate of ascent, genetic factors and history of HAPE.
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Vargas PE, Parent G. Vivir en la Altura. Bolivia: Comisión de Asuntos Estratégicos del Senado Francés y Asociación de Solidaridad Francesa; 2014. p. 22.
Frisancho PD, Frisancho VO. Medicina de la Altura. Puno: Universidad Nacional del Altiplano; 1993. pp. 31-6.
Johnson NJ, Luks AM. High-altitude medicine. Med Clin North Am. 2016; 100(2): 357-69.
Velásquez QMT. El hombre nativo de las grandes alturas. Estudios fisiológicos en los Andes Peruanos. Lima: Instituto Nacional de Salud; 2013.
Lossio J. El peruano y su entorno. Aclimatándose a las alturas andinas. Lima: Instituto de Estudios Peruanos; 2012.
Monge CC, León VF. El reto fisiológico de vivir en los Andes. Lima: Instituto Francés de Estudios Peruanos y Universidad Peruana Cayetano Heredia; 2003.
Reynafarje HC. La adaptación a las grandes alturas. Contribución Peruana a su estudio. Lima: Talleres Propaceb; 1990. p. 11.
Bärtsch P, Swenson ER. Acute high-altitude illnesses. N Engl J Med. 2013; 368(24): 2294-302.
Richalet JP. High altitude pulmonary oedema: ¿still a place for controversy? Thorax. 1995; 50(9): 923-9.
Parakilar SJ, Parakilar JH. High-altitude medicine. Indian J Occup Environ Med. 2010; 14(1): 6-12.
Hultgren HN, Marticorena EA. High altitude pulmonary edema. Epidemiologic observations in Peru. Chest. 1978; 74(4): 372-6.
Tianyi W. The terminology and classification of high altitude disease in China. ISSM Newsletter. 1993; 3(2): 2-4.
Sophocles AM, Bachman J. High-altitude pulmonary edema among visitors to Summit County, Colorado. J Fam Pract. 1983; 17(6): 1015-7.
Accinelli RA, López ML. Enfermedades por exposición a la altura. Arch Bronconeumol. 2018; 54(3): 115-6.
López GD. Edema pulmonar agudo de reascenso: caso observado en Huaraz, Ancash, Perú. Acta Med Per. 2008; 25(2): 92-5.
Merino LA, Vizcarra AJ, López GD, Méndez OJJ, Tinoco SA. Edema agudo de pulmón como presentación del mal de altura grave de reascenso. Revista de Medicina Intensiva y Cuidados Críticos. 2020; 13(1): 21-4.
Merino LA, Vizcarra AJ. Acute lung edema as a presentation of severe acute reentry high-altitude illness in a pediatric patient. Pediatrics. 2020.
Maeder MB, Brugger H, Pun M, Strapazzon G, Dal Cappello T, Maggiorini M, et al. The STAR data reporting guidelines for clinical high altitude research. High Alt Med Biol. 2018; 19(1): 7-14.
Hofmeyr R, Tölken G, De Decker R. Acute high-altitude illness. S Afr J Med. 2017; 107(7): 556-61.
Bardalez VA. Algunos casos de edema pulmonar agudo por soroche grave. An Fac Med. 1955; 38(2): 232-43.
Lizárraga ML. Soroche agudo: edema agudo del pulmón. An Fac Med. 1955; 38(2): 244-74.
Alzamora-Castro V, Garrido-Lecca G, Batillana G. Pulmonary edema of high altitude. Am J Cardiol. 1961; 7(6): 769-78.
Silva JG. Edema agudo pulmonar de altura: cuadro clínico. Diagnóstico. 1984; 14(5): 139-41.
Acevedo BJ, Madera MJ. Edema agudo pulmonar de altura (EAPA) en niños y adolescentes a 4105 msnm. Libro de Resúmenes del II Congreso Peruano de Medicina de Altura. Huancayo; 2001. p. 16.
Gamboa R. Exposición aguda a la hipoxia hipobárica: aspectos fisiológicos y fisiopatológicos. Rev Per Cardiol. 1997; 23(3): 145-56.
Gamboa R. Fisiología y fisiopatología cardiovascular durante la exposición aguda a la altura. Acta Andina. 1998; 7(1): 35-46.
Hughes JMB. Hypoxic pulmonary vasoconstriction: clinical implications. Eur Resp J. 2016; 47(1): 31-4.
Swenson ER. Early hours in the development of high-altitude pulmonary edema: time course and mechanisms. J Appl Physiol. 2020; 128(6): 1539-46.
Pennardt A. High-altitude pulmonary edema: diagnosis, prevention and treatment. Curr Sports Med Rep. 2013; 12(2): 115-9.
Maggiorini M. Prevention and treatment of high-altitude pulmonary edema. Prog Cardiovasc Dis. 2010; 52(6): 500-6.
Sommer N, Strielkov I, Pak O, Weissmann N. Oxygen sensing and signal transduction in hypoxic pulmonary vasoconstriction. Eur Resp J. 2016; 47(1): 288-303.
Reeves JT, Grover RF. Insights by Peruvian scientists into pathogenesis of human chronic hypoxic pulmonary hypertension. J Appl Physiol. 2005; 98(1): 384-9.
Peñaloza D, Arias SJ. The heart and pulmonary circulation at high altitudes: healthy highlanders and chronic mountain sickness. Circulation. 2007; 115(9): 1132-46.
Peñaloza D, Sime F, Ruíz L. Pulmonary hemodynamics in children living at high altitudes. High Alt Med Biol. 2008; 9(3): 199-207.
Luks AM, Schoene RB, Swenson ER. High altitude. En: Courtney BV, ed. Murray and Nadel’s. Texbook of Respiratory Medicine. 6th edition. Philadelphia, Saunders Elsevier, 2016: 1367-84.
Luks AM, Swenson ER, Bärtsch P. Acute high-altitude sickness. Eur Resp Rev. 2017; 26(143): 160096.
Swenson ER, Bärtsch P. High altitude pulmonary edema. Compr Physiol. 2012; 2(4): 2753-73.
Davis C, Hackett P. Advances in the prevention and treatment of high altitude illness. Emerg Med Clin North Am. 2017; 35(2): 241-60.
Parise I. Travelling safely to places at high altitude. Understanding and preventing altitude illness. Am Family Physician. 2017; 46(6): 380-4.
Askel G, Corbaciough SK, Özem C. High altitude illness: management approach. Turk J Emerg Med. 2019; 19(4): 121-6.
Mazur K, Machaj D, Jastrzebska S, Placzed A, Mazur D. Prevention and treatment of high altitude pulmonary edema (HAPE). J Educ Health Sport. 2020; 10 (2): 114-119.
Jackson AIR, Cumpstey AF, Grocott MPW. Acute high altitude pathologies and their treatment. Curr Opin Endocr Metab Res. 2020; 11: 42-8.
Netzer N, Strohl K, Faulhaber M, Gatterer H, Burtscher M. Hypoxiarelated altitude illnesses. J Travel Med. 2013; 20(4): 247-55.
West JB. Highaltitude medicine. Am J Respir Crit Care Med. 2012; 186(12): 1229-37.
Hackett PH, Roach RC. High altitude pulmonary edema. J Wilderness Medicine. 1990; 1(1): 3-26.
Hultgren HN. High altitude medical problems. West J Med. 1979; 131(1): 8-23.
Heath D, Williams DR. High – Altitude Medicine and Pathology. 4th edition. New York, Oxford University Press Inc, 1995: 162-81.
Schoene RB. Illnesses at high altitude. Chest 2008; 134 (2): 402-416.
Marticorena E, Hultgren HN. Evaluation of therapeutic methods in high altitude pulmonary edema. Am J Cardiol. 1979; 43(2): 307-12.
Luks AM. Do we have a “best practice” for treating high altitude pulmonary edema? High Alt Med Biol. 2008; 9(2): 111-4.
Reno E, Danika E, Davis C. The complexity of diagnosing high-altitude pulmonary edema: a case report and review of the differential diagnosis of greater than expected hipoxemia at altitude. High Alt Med Biol. 2019; 20(2): 181-6.
Luks AM, Auerbach PS, Freer L, Grissom CK, Keyes LE, McIntosh SE, et al. Wilderness Medical Society Clinical Practice Guidelines for the prevention and treatment of acute altitude ilness: 2019 update. Wilderness Environ Med. 2019; 30(Suppl. 4): S3-18.
Amstrong C. Acute altitude illness: updated prevention and treatment guidelines from the Wilderness Medical Society. Am Fam Physician. 2020; 101(8): 505-7.
Tinoco SA. Manejo hospitalario del mal de la altura agudo grave. Rev Alli Kaway. 2013; 1(1): 4-7.
Tinoco SA. Mal de altura agudo grave. Libro de Resúmenes del II Congreso Internacional de Medicina de la Altura. La Paz; 2016. p. 11.
Tinoco SA. Edema pulmonar de altura o mal de altura. Rev Finlay. 2018; 8(4): 256-7.
Baniya S, Basnyat B. Mismanagement of severe altitudes illness in a tertiary hospital in Nepal: a cautionary tale. Wilderness Environ Med. 2018; 29 (1): 140-2.
Giesenhagen AM, Ivy D, Brinton JT, Meier MR. Wienman JP. High altitude pulmonary edema in children: a simple referral center evaluation. J Pediatr. 2019; 210: 106-11.
Dobrosielski DA, Leppert KM, Shearer LH, Arce Esquivel AA. “Peru: life at the top”- a study abroad program designed to enhance knowlegde of altitude physiology through experiental learning. J Phys Educ Sport. 2020; 20(4): 1869-78.
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