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Asseri AA, Assiri M, Alshehri N, Alyazidi NS, Alasmari A, Alshabab SQ, Asiri NA. High-Altitude Pulmonary Edema in Two Pediatric Patients with Pre-Existing Lung Disease. Pediatr Rep 2024; 16:271-277. [PMID: 38651462 PMCID: PMC11036292 DOI: 10.3390/pediatric16020023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The illnesses associated with changes in barometric pressure can be classified into three types: acute mountain sickness, high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema. HAPE is a rare form of pulmonary edema that occurs in susceptible individuals after arriving at altitudes over 2500 m above sea level (m). Only a few studies have reported classical HAPE among children with underlying cardiopulmonary comorbidities. In this study, we report two pediatric cases of classical HAPE that occurred immediately upon arriving at Abha city (with an average elevation of 2270 m above sea level). Notably, both patients possessed underlying chronic lung diseases, raising crucial questions about susceptibility factors and the early onset manifestations of HAPE. CASE Two pediatric cases of HAPE are presented. The first patient, with a medical history of repaired right congenital diaphragmatic hernia and subsequent right lung hypoplasia, developed HAPE following their ascent to a high altitude. The second patient, diagnosed with diffuse lung disease of unknown etiology, experienced HAPE after a rapid high-altitude ascent. Both patients resided in low-altitude areas prior to ascent. The initial emergency room assessment revealed that both patients had severe hypoxia with respiratory distress that mandated the initiation of respiratory support and 100% oxygen therapy. They required intensive care unit admission, improved after 5 days of hospitalization, and were sent home in good condition. CONCLUSION HAPE is a complex, potentially life-threatening high-altitude illness with diverse clinical presentations and variable risk factors. This case report sheds light on a potential predisposition factor-pre-existing lung disease-in children experiencing severe HAPE. While further validation is crucial, this valuable insight opens doors for improved preventative strategies and informed medical decisions for children with pre-existing lung conditions traveling to high altitudes.
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Affiliation(s)
- Ali Alsuheel Asseri
- Department of Child Health, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Marei Assiri
- Departments of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia; (M.A.); (N.A.); (N.S.A.); (A.A.)
| | - Norah Alshehri
- Departments of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia; (M.A.); (N.A.); (N.S.A.); (A.A.)
| | - Noha Saad Alyazidi
- Departments of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia; (M.A.); (N.A.); (N.S.A.); (A.A.)
| | - Ahmed Alasmari
- Departments of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia; (M.A.); (N.A.); (N.S.A.); (A.A.)
| | - Saud Q. Alshabab
- College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (S.Q.A.); (N.A.A.)
| | - Nada Abdullah Asiri
- College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (S.Q.A.); (N.A.A.)
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Luks AM, Beidleman BA, Freer L, Grissom CK, Keyes LE, McIntosh SE, Rodway GW, Schoene RB, Zafren K, Hackett PH. Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update. Wilderness Environ Med 2024; 35:2S-19S. [PMID: 37833187 DOI: 10.1016/j.wem.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 10/15/2023]
Abstract
To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention, diagnosis, and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches for managing each form of acute altitude illness that incorporate these recommendations as well as recommendations on how to approach high altitude travel following COVID-19 infection. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine in 2010 and the subsequently updated WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2014 and 2019.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
| | - Beth A Beidleman
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Luanne Freer
- Everest ER, Himalayan Rescue Association, Kathmandu, Nepal
| | - Colin K Grissom
- Pulmonary and Critical Care Medicine, Intermountain Healthcare and the University of Utah, Salt Lake City, UT
| | - Linda E Keyes
- Department of Emergency Medicine, Section of Wilderness Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Scott E McIntosh
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | - George W Rodway
- Department of Family Medicine-Sports Medicine, University of Nevada, Reno School of Medicine, Reno, NV
| | - Robert B Schoene
- Division of Pulmonary and Critical Care Medicine, Sound Physicians, St. Mary's Medical Center and Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA
| | - Ken Zafren
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
- Himalayan Rescue Association, Kathmandu, Nepal
| | - Peter H Hackett
- Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Tanné C, Peyret B, Cherif-Alami S, Navarre M, Pruvost I, Said MH, Baret M, Le Fur E, Basso A, Bonnet-Ducrot S, Desbruyeres C, Mortamet G. What altitude is safe for infants? An expert panel survey. Arch Pediatr 2023; 30:483-485. [PMID: 37704526 DOI: 10.1016/j.arcped.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/13/2023] [Accepted: 06/21/2023] [Indexed: 09/15/2023]
Abstract
AIM To assess advice given to parents who wish to travel to high altitudes with an infant and to provide guidance on this topic. METHOD Using an anonymous self-report survey online, we collected information on the advice provided by practitioners, who practice in mountain environments, to parents who wish to travel to altitude with an infant. General practitioners and pediatricians working in the French Alps were asked about the maximum allowable altitude for different ages and the specific recommendations given. RESULTS A total of 104 practitioners (39% general practitioners) responded to the study. Overall, to spend 1 day at altitude, practitioners recommended a median altitude of 1200, 1500, 1600, and 2000 m for infants under 1, 3, 12, and 24 months, respectively. Their main recommendations for infant protection focused on cold protection, increased hydration, and increased humidity level in the ambient air. Prevention of sudden infant death syndrome was essential according to the respondents. For infants with upper airway infection, most of the participants (90%, n = 94) recommended against traveling to altitude. CONCLUSION This survey revealed a certain consensus about the maximum travel altitude to be recommended for infants.
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Affiliation(s)
- Corentin Tanné
- Ifremmont - Institut de Recherche et de Formation en Médecine de Montagne, Chamonix, France; Pediatric Department, Chambéry Hospital Chambéry, Ifremmont, Chamonix, France.
| | - Blandine Peyret
- Neonatal Intensive Care Unit, Annecy-Genevois Hospital, Annecy, France
| | - Sophia Cherif-Alami
- Pediatric Department, Hôpitaux du pays du Mont Blanc, 74700 Sallanches, France
| | - Manon Navarre
- Medical office, Megeve, France; Médecins de Montagne Association, Chambéry, France
| | | | | | - Marie Baret
- Pediatric Department, Voiron Hospital, Voiron, France
| | - Estelle Le Fur
- Maternity Department, Clinique Cèdres Echirolles, Echirolles, France
| | - Amélie Basso
- Pediatric Department, Albertville Hospital, Albertville, France
| | | | | | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble University Hospital, Grenoble, France
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Zubieta-Calleja GR, Zubieta-DeUrioste N. High Altitude Pulmonary Edema, High Altitude Cerebral Edema, and Acute Mountain Sickness: an enhanced opinion from the High Andes - La Paz, Bolivia 3,500 m. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:327-338. [PMID: 35487499 DOI: 10.1515/reveh-2021-0172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/21/2022] [Indexed: 06/02/2023]
Abstract
Traveling to high altitudes for entertainment or work is sometimes associated with acute high altitude pathologies. In the past, scientific literature from the lowlander point of view was primarily based on mountain climbing. Sea level scientists developed all guidelines, but they need modifications for medical care in high altitude cities. Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema are medical conditions that some travelers can face. We present how to diagnose and treat acute high altitude pathologies, based on 51 years of high altitude physiology research and medical practice in hypobaric hypoxic diseases in La Paz, Bolivia (3,600 m; 11,811 ft), at the High Altitude Pulmonary and Pathology Institute (HAPPI - IPPA). These can occasionally present after flights to high altitude cities, both in lowlanders or high-altitude residents during re-entry. Acute high altitude ascent diseases can be adequately diagnosed and treated in high altitude cities following the presented guidelines. Treating these high-altitude illnesses, we had no loss of life. Traveling to a high altitude with sound medical advice should not be feared as it has many benefits. Nowadays, altitude descent and evacuation are not mandatory in populated highland cities, with adequate medical resources.
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Affiliation(s)
- Gustavo R Zubieta-Calleja
- High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia
- Department of Physiology, Shri B.M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapur 586103, Karnataka, India
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Ucrós S, Aparicio C, Castro-Rodriguez JA, Ivy D. High altitude pulmonary edema in children: A systematic review. Pediatr Pulmonol 2023; 58:1059-1067. [PMID: 36562650 DOI: 10.1002/ppul.26294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION High altitude pulmonary edema (HAPE) is a form of acute noncardiogenic pulmonary edema caused by altitude-related hypoxia seen in children as well as in adults. In this systematic review we focus in HAPE occurring in children and adolescents. METHODS A systematic review was conducted including publications in children 0-18 years of age from three databases up to June 2022. RESULTS Thirty-five studies representing 210 cases were found. The mean age was 9.8 ± 3.6 years with a male/female ratio of 2.6. The peak age incidence was seen in children between 6 and 10 years old. Only two children (0.9%) were ≤2 years old. The mean altitude in 166 cases was 2861 masl. Only 17 cases (8.1%) occurred at altitudes below 2500 masl. Regarding the different HAPE subtypes there was a predominance of re-entry HAPE (R-HAPE) with 58%, followed by classic HAPE (C-HAPE) with 37.6%. The mean time between arrival and onset of symptoms was 16.5 h. The mortality rate was 1.4%. In 10/28 (36%) of C-HAPE cases there was a structural cardiac/pulmonary anomaly compared to 1/19 (5%) in R-HAPE (p < 0.01). HAPE recurrence was found in 46 cases (21.9%). The involvement in the chest X-rays was seen predominantly in the apices and in the right lung. CONCLUSIONS R-HAPE was the most common HAPE subtype; HAPE peak age was found between 6 and 10 years of age; HAPE was more frequent in males and was rare in children under 2 years old; associated HAPE structural abnormalities were more common in C-HAPE than in R-HAPE.
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Affiliation(s)
- Santiago Ucrós
- Department of Pediatrics, Universidad de los Andes School of Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Camila Aparicio
- Universidad de los Andes School of Medicine Bogotá, Bogotá, Colombia
| | - Jose A Castro-Rodriguez
- Division of Pediatrics School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dunbar Ivy
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Kelly TD, Meier M, Weinman JP, Ivy D, Brinton JT, Liptzin DR. High-Altitude Pulmonary Edema in Colorado Children: A Cross-Sectional Survey and Retrospective Review. High Alt Med Biol 2022; 23:119-124. [PMID: 35384735 DOI: 10.1089/ham.2021.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Kelly, Timothy D., Maxene Meier, Jason P. Weinman, Dunbar Ivy, John T. Brinton, and Deborah R. Liptzin. High-altitude pulmonary edema in Colorado children: a cross-sectional survey and retrospective review. High Alt Med Biol. 23:119-124, 2022. Introduction: Few studies of high-altitude pulmonary edema (HAPE) are specific to the pediatric population. The purpose of this investigation was to further characterize the radiographic patterns of pediatric HAPE, and to better understand ongoing risk following an initial pediatric HAPE episode. Methods: This study uses both a retrospective chart review and cross-sectional survey. Pediatric patients with HAPE at a single quaternary referral center in the Rocky Mountain Region were identified between the years 2013 and 2020. Patients were eligible if they presented with a clinical diagnosis of HAPE and had a viewable chest radiograph (CXR). Surveys were sent to eligible patients/families to gather additional information relating to family history, puberty, and HAPE recurrence. Results: Forty-two individuals met criteria for clinical diagnosis of HAPE with a viewable CXR. A majority of CXRs (24/42, 57.1%) demonstrated predominant right-sided involvement. Similarly, 24 CXRs (24/42, 57.1%) demonstrated predominant upper lobe involvement. Twenty-one (21/42, 50%) surveys were completed. A minority of individuals went on to experience at least one other HAPE episode (8/19, 42.1%). Conclusion: The most common radiographic pattern seen in pediatric HAPE is pulmonary edema that favors the right lung and upper lobes. After an initial HAPE presentation, some children will experience additional HAPE episodes.
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Affiliation(s)
- Timothy D Kelly
- Indiana University Emergency Medicine Residency, Indianapolis, Indiana, USA
| | - Maxene Meier
- Research Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jason P Weinman
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Dunbar Ivy
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John T Brinton
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Deborah R Liptzin
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Rieger M, Algaze I, Rodriguez-Vasquez A, Smith K, Stembridge M, Smith B, Radom-Aizik S, McManus A. Kids With Altitude: Acute Mountain Sickness and Changes in Body Mass and Total Body Water in Children Travelling to 3800 m. Wilderness Environ Med 2022; 33:33-42. [PMID: 34998707 DOI: 10.1016/j.wem.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We explored the incidence of acute mountain sickness (AMS) and extravascular lung water (ELW) in children in relation to changes in body composition and peripheral blood oxygenation (SpO2) during 1 week of acclimatization to 3800 m. METHODS In a prospective cohort study, 10 children (7 female, ages 7-14 y) and 10 sex-matched adults (ages 23-44 y) traveled via automobile from sea level to 3000 m for 2 nights, followed by 4 nights at 3800 m. Each morning, body mass and body water (bioelectrical impedance), SpO2 (pulse oximetry), AMS (Lake Louise Questionnaire), and ELW (transthoracic echocardiography) were measured. RESULTS No differences were found between children and adults in SpO2 or ELW. At 3800 m 7 of 10 children were AMS+ vs 4 of 10 adults. Among those AMS+ at 3800 m, the severity was greater in children compared to adults (5±1 vs 3 ± 0; P=0.005). Loss of body mass occurred more quickly in children (day 5 vs day 7) and to a greater extent (-7±3% vs -2±2%; P<0.001); these changes were mediated via a larger relative loss in total body water in children than in adults (-6±5% vs -2±2%; P=0.027). CONCLUSIONS Children demonstrated a higher incidence of AMS than adults, with greater severity among those AMS+. The loss of body water and body mass at high altitude was also greater in children, albeit unrelated to AMS severity. In addition to awareness of AMS, strategies to maintain body weight and hydration in children traveling to high altitudes should be considered.
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Affiliation(s)
- Matt Rieger
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada.
| | - Isabel Algaze
- Department of Emergency Medicine, University of California Irvine Medical Center, Orange, California
| | - Adriana Rodriguez-Vasquez
- Department of Emergency Medicine, University of California Irvine Medical Center, Orange, California
| | - Kurt Smith
- Cerebrovascular Health, Exercise, and Environmental Research Sciences Laboratory, School of Exercise Sciences and Physical Health Education, University of Victoria, Victoria, Canada
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Brianne Smith
- Cerebrovascular Health, Exercise, and Environmental Research Sciences Laboratory, School of Exercise Sciences and Physical Health Education, University of Victoria, Victoria, Canada
| | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center, University of California Irvine School of Medicine, Irvine, California
| | - Alison McManus
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
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Diaz GF, Marquez A, Ruiz-Parra A, Beghetti M, Ivy D. An Acute Hyperoxia Test Predicts Survival in Children with Pulmonary Hypertension Living at High Altitude. High Alt Med Biol 2021; 22:395-405. [PMID: 34905397 PMCID: PMC8742266 DOI: 10.1089/ham.2021.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Diaz, Gabriel F., Alicia Marquez, Ariel Ruiz-Parra, Maurice Beghetti, and Dunbar Ivy. An acute hyperoxia test predicts survival in children with pulmonary hypertension living at high altitude. High Alt Med Biol. 22:395-405, 2021. Background: Pulmonary hypertension (PH) causes significant morbidity and mortality in children at altitude. Materials and Methods: Fifty-two children living at 2,640 m were included. During hyperoxia test (O2Test), patients received high oxygen concentrations (FiO2 >80, through Mask, using Venturi or nonrebreathing mask); echocardiography was used to evaluate pulmonary vasculature reactivity. A decrease >20% from the basal pulmonary artery systolic pressure was considered a positive response. Results: Most of the patients had severe PH. The median age at diagnosis was 4.5 years; 34 were female (65.4%). Idiopathic PH was present in 44 patients (84.6%). Six developed severe PH after ductus closure. They were classified in responders (n = 25), and nonresponders (n = 26). Responders were younger (3 years vs. 7 years, p = 0.02), and 22 (88%), had better functional class (FC) 1-2, than nonresponders: 18 (69.23%) of them had worse FC: 3-4 (p = 0.000). In responders, 10/12 who went to live at low altitude became asymptomatic, compared with 7/13 who remained at high altitude. FC 1-2 was achieved by 70% of the patients with idiopathic PH who went to a low altitude, compared with 30% who continued at high altitude (p = 0.03). In nonresponders, 10/26 patients moved to a low altitude: four improved, one worsened, and five died; of the 16/26 patients living at high altitude, four are stable, eight worsened, and four died. Four patients (30.76%) in responder group and nine (69.24%) in the nonresponder group died (p = 0.03). There were differences between both groups in systolic (88 mm Hg vs. 110 mm Hg; p = 0.037), diastolic (37 mm Hg vs. 56 mm Hg; p = 0.035), and mean pulmonary artery pressures (57 mm Hg vs. 88 mm Hg; p = 0.038). Conclusions: This specific hyperoxia test applied until 24 hours (not published before) helps to predict survival and prognosis of children with PH. Children with PH at a high altitude improve at low altitude.
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Affiliation(s)
- Gabriel F Diaz
- Department of Pediatrics, Universidad Nacional de Colombia, Fundación Santa Fe de Bogotá, Bogotá Colombia
| | - Alicia Marquez
- Clínica De La Mujer, Centro Policlínico del Olaya, Bogotá, Colombia
| | - Ariel Ruiz-Parra
- Instituto de Investigaciones Clínicas and Department of Obstetrics and Gynecology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Maurice Beghetti
- Head of Pediatric Cardiology Unit (HUG), Director Pulmonary Hypertension Program (HUG) Children's University Hospital, Geneva, Switzerland
| | - Dunbar Ivy
- Chief and Selby's Chair of Pediatric Cardiology, University of Colorado, School of Medicine, Children's Hospital Colorado, Denver, Colorado, USA
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Lang M, Vizcaíno-Muñoz G, Jopia P, Silva-Urra J, Viscor G. Physiological Responses at Rest and Exercise to High Altitude in Lowland Children and Adolescents. Life (Basel) 2021; 11:1009. [PMID: 34685380 PMCID: PMC8541065 DOI: 10.3390/life11101009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
During the last decades, the number of lowland children exposed to high altitude (HA) has increased drastically. Several factors may influence the development of illness after acute HA exposure on children and adolescent populations, such as altitude reached, ascent velocity, time spent at altitude and, especially, their age. The main goal of this study was to evaluate the resting cardiorespiratory physiological and submaximal exercise responses under natural HA conditions by means of the six-minute walking test (six MWT). Secondly, we aimed to identify the signs and symptoms associated with acute mountain sickness (AMS) onset after acute HA exposure in children and adolescents. Forty-two children and adolescents, 18 boys and 24 girls aged from 11 to 15 years old, participated in this study, which was performed at sea level (SL) and during the first 42 h at HA (3330 m). The Lake Louise score (LLS) was recorded in order to evaluate the evolution of AMS symptoms. Submaximal exercise tests (six MWT) were performed at SL and HA. Physiological parameters such as heart rate, systolic and diastolic blood pressure, respiratory rate and arterialized oxygen saturation were measured at rest and after ending exercise testing at the two altitudes. After acute HA exposure, the participants showed lower arterial oxygen saturation levels at rest and after the submaximal test compared to SL (p < 0.001). Resting heart rate, respiratory rate and diastolic blood pressure presented higher values at HA (p < 0.01). Moreover, heart rate, diastolic blood pressure and dyspnea values increased before, during and after exercise at HA (p < 0.01). Moreover, submaximal exercise performance decreased at HA (p < 0.001). The AMS incidence at HA ranged from 9.5% to 19%, with mild to moderate symptoms. In conclusion, acute HA exposure in children and adolescent individuals produces an increase in basal cardiorespiratory parameters and a decrement in arterial oxygen saturation. Moreover, cardiorespiratory parameters increase during submaximal exercise at HA. Mild to moderate symptoms of AMS at 3330 m and adequate cardiovascular responses to submaximal exercise do not contraindicate the ascension of children and adolescents to that altitude, at least for a limited period of time.
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Affiliation(s)
- Morin Lang
- Department of Rehabilitation Sciences and Human Movement, Faculty of Health Sciences, University of Antofagasta, Antofagasta 1240000, Chile
| | - Guillem Vizcaíno-Muñoz
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, E-08028 Barcelona, Spain; (G.V.-M.); (G.V.)
| | - Paulina Jopia
- Occupational Health Department, Institute of Occupational Safety, Copiapó 1530000, Chile;
| | - Juan Silva-Urra
- Biomedical Department, Faculty of Health Sciences, University of Antofagasta, Antofagasta 1240000, Chile;
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, E-08028 Barcelona, Spain; (G.V.-M.); (G.V.)
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Cassibba J, Mortamet G. Characteristics and Management of Severe Bronchiolitis Occurring in Ski Resorts in the French Alps: A Case Series. Pediatr Emerg Care 2021; 37:e68. [PMID: 32868624 DOI: 10.1097/pec.0000000000002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xu J, Lv L, He B, Wang G, Bianbazhuoma, Kong D. Characteristics of High Altitude Pulmonary Edema in Naqu at the Altitude of 4500 m. Am J Med Sci 2020; 362:154-160. [PMID: 34083021 DOI: 10.1016/j.amjms.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/21/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND We aimed to review records from 429 patients with high altitude pulmonary edema (HAPE) to identify some of the salient characteristics associated with this condition. MATERIALS AND METHODS General information and clinical symptoms, along with laboratory test results from HAPE patients were collected and analyzed. Blood assay results and imaging at admission were compared with those at discharge. Results from routine blood assays were compared among three subgroups of these patients that were generated based upon the duration of their hypoxia exposure. RESULTS Of these 429 HAPE patients, 9.32% also showed high altitude cerebral edema (HACE). White blood cell and neutrophil counts, as well as levels of alanine aminotransferase and aspartate aminotransferase, uric acid, lactic dehydrogenase and creatine kinase were all increased in HAPE patients, with further increases observed in those with HAPE combined with HACE. Levels of white blood cells, neutrophils, lymphocytes, and hemoglobin concentrations in HAPE patients at admission were significantly higher than that obtained at discharge. White blood cell and neutrophil counts were lower in patients who developed HAPE after a duration of 7 days of high altitude exposure as compared with those who developed the condition within 1 or 3 days. CONCLUSIONS A combination of HAPE and HACE was present in 9.32% of the patients with HAPE. HAPE was more prevalent in males. Hepatocytes and the myocardium were likely sites of damage in patients with HAPE, with more severe damage observed in the patients with HAPE/HACE. White blood cell and neutrophil counts were significantly higher than normal ranges and these levels were negatively correlated with the duration of hypoxia exposure.
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Affiliation(s)
- Jiahuan Xu
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China; Institute of Respiratory Medicine, Zhejiang Hospital, Hangzhou, China
| | - Lianggang Lv
- Institute of Respiratory Medicine, People's Hospital of Naqu, Naqu, China
| | - Bo He
- Institute of Respiratory Medicine, People's Hospital of Naqu, Naqu, China
| | - Guoqiang Wang
- Institute of Respiratory Medicine, People's Hospital of Naqu, Naqu, China
| | - Bianbazhuoma
- Institute of Respiratory Medicine, People's Hospital of Naqu, Naqu, China
| | - Delei Kong
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China.
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Bates ML, Levy PT, Nuyt AM, Goss KN, Lewandowski AJ, McNamara PJ. Adult Cardiovascular Health Risk and Cardiovascular Phenotypes of Prematurity. J Pediatr 2020; 227:17-30. [PMID: 32931771 DOI: 10.1016/j.jpeds.2020.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA; Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Anne Monique Nuyt
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Kara N Goss
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Patrick J McNamara
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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13
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Sonnet M, Hullo E, Mortamet G. Can infants travel safely to mountain resorts? Arch Pediatr 2020; 27:354-355. [PMID: 32893109 DOI: 10.1016/j.arcped.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/23/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- M Sonnet
- Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, 38700 La Tronche, France
| | - E Hullo
- Pediatric Department, CHU Grenoble-Alpes, 38700 La Tronche, France
| | - G Mortamet
- Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, 38700 La Tronche, France.
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14
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Acute Lung Edema as a Presentation of Severe Acute Reentry High-Altitude Illness in a Pediatric Patient. Case Rep Pediatr 2020; 2020:8871098. [PMID: 32908766 PMCID: PMC7477612 DOI: 10.1155/2020/8871098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/21/2020] [Indexed: 12/02/2022] Open
Abstract
Acute high-altitude pulmonary edema (HAPE) is a pathology involving multifactorial triggers that are associated with ascents to altitudes over 2,500 meters above sea level (m). Here, we report two pediatric cases of reentry HAPE, from the city of Huaraz, Peru, located at 3,052 m. The characteristics of both cases were similar, wherein acclimatization to sea level and a subsequent return to the city of origin occurred, and we speculate that it was caused by activation of predisposing factors to HAPE. The diagnosis and management associated with pulmonary hypertension became a determining factor for therapy.
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15
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Kinder und Höhe. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Takken T, Evertse A, de Waard F, Spoorenburg M, Kuijpers M, Schroer C, Hulzebos EH. Exercise responses in children and adults with a Fontan circulation at simulated altitude. CONGENIT HEART DIS 2019; 14:1005-1012. [PMID: 31602790 PMCID: PMC7003737 DOI: 10.1111/chd.12850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/30/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traveling to high altitude has become more popular. High-altitude exposure causes hypobaric hypoxia. Exposure to acute high altitude, during air travel or mountain stays, seems to be safe for most patients with congenital heart disorders (CHD). Still, current guidelines for CHD patients express concerns regarding safety of altitude exposure for patients with a Fontan circulation. Therefore, investigating hemodynamic and pulmonary responses of acute high-altitude exposure (±2500 m) at rest and during maximal exercise in patients with Fontan circulation can provide clarity in this dispute and may contribute to improvement of clinical counseling. METHODS Twenty-one Fontan patients with 21 age-matched healthy controls, aged 8-40 years, were enrolled in an observational study. Participants performed two cardiopulmonary exercise tests on a cycle ergometer with breath-by-breath respiratory gas analyses combined with noninvasive impedance cardiac output measurements: one at sea level (±6 m) and one at simulated high altitude (±2500 m), respectively. RESULTS The effect of altitude exposure was different in rest for saturation (-2.3% vs -4.1%) between Fontan patients and healthy controls (P < .05). At peak exercise the effects of high altitude exposure was different on VO2 (-5.1% vs 9.6%) and AvO2 -diff (-0.3% vs -12.8%) between Fontan patients and healthy controls. CONCLUSION Although, acute high-altitude exposure has a detrimental effect on exercise capacity, the impact on pulmonary and hemodynamic responses of high-altitude exposure is comparable between Fontan patients and healthy controls.
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Affiliation(s)
- Tim Takken
- Department of Medical Physiology, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alyanne Evertse
- Department of Medical Physiology, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Fleur de Waard
- Department of Medical Physiology, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mandy Spoorenburg
- Department of Medical Physiology, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martijn Kuijpers
- Department of Medical Physiology, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christian Schroer
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Pediatrics, Maxima Medical Center Veldhoven, Veldhoven, the Netherlands
| | - Erik H Hulzebos
- Department of Medical Physiology, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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17
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Aksel G, Çorbacıoğlu ŞK, Özen C. High-altitude illness: Management approach. Turk J Emerg Med 2019; 19:121-126. [PMID: 31687609 PMCID: PMC6819752 DOI: 10.1016/j.tjem.2019.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 09/15/2019] [Accepted: 09/15/2019] [Indexed: 11/30/2022] Open
Abstract
In high altitudes, usually above 2500 m, travelers are faced with decreased partial pressure of oxygen along with decreased barometric pressure. High-altitude illness, a syndrome of acute mountain sickness, high-altitude cerebral edema and high-altitude pulmonary edema, occurs due to the hypobaric hypoxia when there is inadequate acclimatization. This review provides detailed information about pathophysiology, clinical features, prevention and treatment strategies for high-altitude illness according to the current literature.
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Affiliation(s)
- Gökhan Aksel
- University of Health Sciences, Ümraniye Training and Research Hospital, Emergency Medicine Clinic, İstanbul, Turkey
| | - Şeref Kerem Çorbacıoğlu
- University of Health Sciences, Keçiören Training and Research Hospital, Emergency Medicine Clinic, Ankara, Turkey
| | - Can Özen
- Emergency Department, King's College Hospital, London, UK
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18
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Pediatric High Altitude Cerebral Edema in the Nepal Himalayas. Wilderness Environ Med 2019; 30:306-309. [PMID: 31301992 DOI: 10.1016/j.wem.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/24/2019] [Accepted: 05/15/2019] [Indexed: 11/20/2022]
Abstract
High altitude cerebral edema (HACE) is a rare complication of ascent to altitudes of over 2500 m (8200 ft). We are not aware of a previously published case report of HACE in a patient under the age of 18 y. We report on 2 cases of suspected HACE in 2 patients, aged 12 and 16 y, who presented to the Manang Himalayan Rescue Association clinic at 3500 m. The 16-y-old patient presented with severe headache, vomiting, and ataxia after rapid ascent to 3800 m. The 12-y-old patient presented with severe headache, vomiting, visual disturbances, and ataxia at 4500 m, which began to resolve with descent to the clinic at 3500 m. Our cases suggest that HACE can occur in children and adolescents. Because there are no specific guidelines for treatment of acute mountain sickness or HACE in patients under the age of 18 y, we recommend treatment as for adults: oxygen, immediate descent, and dexamethasone. Simulated descent in a portable hyperbaric chamber can be used if oxygen is not available and if actual descent is not possible.
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19
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Giesenhagen AM, Ivy D, Brinton JT, Meier MR, Weinman JP, Liptzin DR. High Altitude Pulmonary Edema in Children: A Single Referral Center Evaluation. J Pediatr 2019; 210:106-111. [PMID: 31005280 PMCID: PMC6592742 DOI: 10.1016/j.jpeds.2019.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe the clinical features of children who presented to Children's Hospital Colorado (CHCO) with high-altitude pulmonary edema (HAPE). STUDY DESIGN We performed a retrospective chart review in children discharged from CHCO (an elevation of 1668 m) with a clinical diagnosis of HAPE and a chest radiograph consistent with noncardiogenic pulmonary edema. Descriptive statistics were used to describe the demographics, presentations, and treatment strategies. RESULTS From 2004 to 2014, 50 children presented to CHCO who were found to have a clinical diagnosis of HAPE and a chest radiograph consistent with noncardiogenic pulmonary edema. Most (72%) patients were male, and most (60%) of the children in the study were diagnosed with classic HAPE, 38% with re-entry HAPE, and 2% with high altitude resident pulmonary edema. Elevation at symptom presentation ranged from 1840 to 3536 m. Patients were treated with a variety of medications, including diuretics, steroids, and antibiotics. Four patients were newly diagnosed with structural heart findings: 2 patients with patent foramen ovale and 2 with atrial septal defects. Eleven patients had findings consistent with pulmonary hypertension at the time of echocardiography. CONCLUSIONS HAPE symptoms may develop below 2500 m, so providers should not rule out HAPE based on elevation alone. Structural heart findings and pulmonary hypertension are associated with HAPE susceptibility and their presence may inform treatment. Inappropriate use of antibiotics and diuretics in children with HAPE suggest that further education of providers is warranted.
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Affiliation(s)
- Ann M. Giesenhagen
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Dunbar Ivy
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - John T. Brinton
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado, Aurora, CO
| | - Maxene R. Meier
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado, Aurora, CO
| | - Jason P. Weinman
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO
| | - Deborah R. Liptzin
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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20
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Luks AM, Auerbach PS, Freer L, Grissom CK, Keyes LE, McIntosh SE, Rodway GW, Schoene RB, Zafren K, Hackett PH. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update. Wilderness Environ Med 2019; 30:S3-S18. [PMID: 31248818 DOI: 10.1016/j.wem.2019.04.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/12/2019] [Accepted: 04/19/2019] [Indexed: 12/16/2022]
Abstract
To provide guidance to clinicians about best preventive and therapeutic practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each form of acute altitude illness that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2010 and subsequently updated as the WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness in 2014.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
| | - Paul S Auerbach
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | - Luanne Freer
- Yellowstone National Park, WY; Midway Atoll National Wildlife Refuge, Honolulu, HI; Everest ER, Himalayan Rescue Association, Kathmandu, Nepal
| | - Colin K Grissom
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Denver, CO; Boulder Community Health, Boulder, CO
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT
| | - George W Rodway
- University of California, Davis School of Nursing, Sacramento, CA
| | - Robert B Schoene
- Division of Pulmonary and Critical Care Medicine, Sound Physicians, St. Mary's Medical Center, San Francisco, CA
| | - Ken Zafren
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA; Himalayan Rescue Association, Kathmandu, Nepal
| | - Peter H Hackett
- Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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21
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Liptzin DR, Abman SH, Giesenhagen A, Ivy DD. An Approach to Children with Pulmonary Edema at High Altitude. High Alt Med Biol 2018; 19:91-98. [PMID: 29470103 DOI: 10.1089/ham.2017.0096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Liptzin, Deborah R., Steven H. Abman, Ann Giesenhagen, and D. Dunbar Ivy. An approach to children with pulmonary edema at high altitude. High Alt Med Biol. 19:91-98, 2018. INTRODUCTION Diagnosis of high-altitude illness can be more challenging in children, especially those who are preverbal. Families often travel to high elevations for family vacations, either for skiing, hiking, and/or camping. They may present to their primary care providers looking for anticipatory guidance before travel or may follow-up after developing high-altitude illness. High-altitude pulmonary edema (HAPE) can be fatal. OBSERVATIONS There is no indication for HAPE prophylaxis in altitude naive children. Children may develop HAPE either when traveling from low altitude to high altitude for vacation (classic HAPE), when returning to high-altitude homes after travel to low altitude (reentry HAPE), or even with a respiratory illness at high altitude without any change in elevation (high-altitude resident pulmonary edema or HARPE). Children may be more susceptible to HAPE because of increased vascular reactivity, immature control of breathing, and increased frequency of respiratory illnesses. Children with HAPE warrant evaluation for underlying cardiopulmonary abnormalities, including structural heart disease and pulmonary hypertension. Treatment of HAPE includes supplemental oxygen and descent, but underlying cardiopulmonary disease may also help guide treatment and prevention. CONCLUSIONS AND RELEVANCE Evaluation for structural heart disease and pulmonary hypertension should be considered in children with HAPE. Future studies should be done to elucidate the optimal strategies for prevention and treatment of HAPE and to better understand the development of HAPE in children.
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Affiliation(s)
- Deborah R Liptzin
- 1 Breathing Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado
| | - Steven H Abman
- 1 Breathing Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado
| | - Ann Giesenhagen
- 2 Heart Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado
| | - D Dunbar Ivy
- 2 Heart Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado
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22
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Özge A, Abu-Arafeh I, Gelfand AA, Goadsby PJ, Cuvellier JC, Valeriani M, Sergeev A, Barlow K, Uludüz D, Yalın OÖ, Faedda N, Lipton RB, Rapoport A, Guidetti V. Experts' opinion about the pediatric secondary headaches diagnostic criteria of the ICHD-3 beta. J Headache Pain 2017; 18:113. [PMID: 29285571 PMCID: PMC5745369 DOI: 10.1186/s10194-017-0819-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022] Open
Abstract
Background The 2013 International Classification of Headache Disorders-3 was published in a beta version to allow clinicians to confirm the validity of the criteria or suggest improvements based on field studies. The aim of this work was to review the Secondary Headache Disorders and Cranial Neuralgias and Other Headache Disorders sections of ICHD-3 beta data on children and adolescents (age 0–18 years) and to suggest changes, additions, and amendments. Methods Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the available literature on pediatric headache, they made observations and proposed suggestions for the mentioned headache disorders on children and adolescents. Results Some headache disorders in children have specific features, which are different from adults that should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psychosocial basis in children and adolescents making primary headache disorders in children distinct from those in adults. Conclusions Several recommendations are presented in order to make ICHD-3 more appropriate for use in children.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | | | - Amy A Gelfand
- UCSF Headache Center and UCSF Benioff Children's Hospital Pediatric Brain Center 2330 Post St, 6th Floor, Campus Box 1675, San Francisco, CA, 94115, USA
| | - Peter James Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
| | - Jean Christophe Cuvellier
- Division of Paediatric Neurology, Department of Paediatrics, Lille Faculty of Medicine and Children's Hospital, Lille, France
| | - Massimiliano Valeriani
- Division of Neurology, Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy.,Center for Sensory-Motor Interaction Aalborg University, Aalborg, Denmark
| | - Alexey Sergeev
- Department of Neurology and Clinical Neurophysiology, University Headache Clinic, Moscow State Medical University, Moscow, Russia
| | - Karen Barlow
- Faculty of Medicine, University of Calgary, Alberta Children's Hospital, C4-335, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada
| | - Derya Uludüz
- Cerrahpaşa Medical Faculty, Deaprtment of Neurology, İstanbul University, Kocamustafapaşa, İstanbul, Turkey
| | - Osman Özgür Yalın
- İstanbul Research and Education Hospital, Kocamustafapaşa, İstanbul, Turkey
| | - Noemi Faedda
- Phd program in Behavioural Neuroscience, Department of Paediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Richard B Lipton
- Department of Psychiatry and Behavioral Sciences, Department of Epidemiology & Population Health, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alan Rapoport
- The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vincenzo Guidetti
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy.
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Cheng FY, Jeng MJ, Lin YC, Wang SH, Wu SH, Li WC, Huang KF, Chiu TF. Incidence and severity of acute mountain sickness and associated symptoms in children trekking on Xue Mountain, Taiwan. PLoS One 2017; 12:e0183207. [PMID: 28832689 PMCID: PMC5568320 DOI: 10.1371/journal.pone.0183207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 08/01/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acute mountain sickness (AMS) occurs in non-acclimatized people after an acute ascent to an altitude of 2,500 m or higher. The aim of this study was to examine the incidence and severity of AMS and associated symptoms in children. METHODS The prospective observational study included 197 healthy, non-acclimatized 11 and 12-year-old children trekking the round-trip from the trailhead to the summit of Xue Mountain, Taiwan (2,179 m to 3,886 m) over 3 days. AMS was evaluated at Qika Hut (2,460 m) on Day 1, at Sanliujiu Hut on Day 2 (3,100 m), and at the same altitude (3,100 m) after reaching the summit on Day 3. We used the Lake Louise Score (LLS) to diagnose AMS and record daily AMS-associated symptoms. We gave acetazolamide to children with mild to moderate AMS. Dexamethasone was reserved for individuals suffering from severe AMS. Acetaminophen was administrated to children with headache, and metoclopramide for those with nausea or vomiting. RESULTS There were 197 subjects eligible for analysis. The overall incidence of AMS was 40.6%, which was higher in males and in subjects with a higher body mass index (BMI) (p < 0.05). The prevalence of AMS on Day 1 was 5.6%, which was significantly lower than that on Day 2 (29.4%) and Day 3 (23.4%). The mean LLS of all subjects was 1.77 ± 2.08. The overall incidence of severe AMS (LLS ≥ 5) was 12.5%. The mean LLS of the AMS group (3.02 ± 2.46) was significantly higher than that of the non-AMS group (0.92 ± 1.16, p < 0.001). Among the AMS group, the mean LLS was 1.00 ± 1.55 on Day 1, 4.09 ± 1.97 on Day 2, and 3.98 ± 2.42 on Day 3. The most common symptom was sleep disturbance followed by dizziness, and headache. The prevalence of headache was 46.2% on Day 2 at 3,100 m, and 31.3% on Day 3 at the same altitude after climbing the summit (3,886 m). Males experienced significantly more headache and fatigue than females (p < 0.05). The LLS and prevalence of all AMS symptoms were significantly higher in the AMS than the non-AMS group (p < 0.05). CONCLUSIONS The AMS incidence among children trekking to Xue Mountain was 40.6%. AMS is common and mostly manifests as mild symptoms. Gender (male) and a higher BMI could be considered two independent risk factors of higher AMS incidence. Sleep disturbance is the most common symptom, and the lower prevalence of headache on Day 3 may be due to the effects of medication and/or acclimatization.
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Affiliation(s)
- Fei-Ying Cheng
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yin-Chou Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
| | - Shih-Hao Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
- Department of Recreation and Leisure Industry Management, College of Management, National Taiwan Sport University, Taoyuan, Taiwan
- Taiwan Wilderness Medical Association, New Taipei City, Taiwan
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Chiayi, Taiwan
| | - Shih-Hao Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Cheng Li
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Health Management, Xiamen Chang Gung Hospital, Xiamen, China
| | - Kuo-Feng Huang
- Department of Physical Education, National Taitung University, Taitung, Taiwan
- Department of Emergency Medicine, West Garden Hospital, Taipei, Taiwan
| | - Te-Fa Chiu
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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24
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Donegani E, Paal P, Küpper T, Hefti U, Basnyat B, Carceller A, Bouzat P, van der Spek R, Hillebrandt D. Drug Use and Misuse in the Mountains: A UIAA MedCom Consensus Guide for Medical Professionals. High Alt Med Biol 2016; 17:157-184. [PMID: 27583821 DOI: 10.1089/ham.2016.0080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Donegani, Enrico, Peter Paal, Thomas Küpper, Urs Hefti, Buddha Basnyat, Anna Carceller, Pierre Bouzat, Rianne van der Spek, and David Hillebrandt. Drug use and misuse in the mountains: a UIAA MedCom consensus guide for medical professionals. High Alt Med Biol. 17:157-184, 2016.-Aims: The aim of this review is to inform mountaineers about drugs commonly used in mountains. For many years, drugs have been used to enhance performance in mountaineering. It is the UIAA (International Climbing and Mountaineering Federation-Union International des Associations d'Alpinisme) Medcom's duty to protect mountaineers from possible harm caused by uninformed drug use. The UIAA Medcom assessed relevant articles in scientific literature and peer-reviewed studies, trials, observational studies, and case series to provide information for physicians on drugs commonly used in the mountain environment. Recommendations were graded according to criteria set by the American College of Chest Physicians. RESULTS Prophylactic, therapeutic, and recreational uses of drugs relevant to mountaineering are presented with an assessment of their risks and benefits. CONCLUSIONS If using drugs not regulated by the World Anti-Doping Agency (WADA), individuals have to determine their own personal standards for enjoyment, challenge, acceptable risk, and ethics. No system of drug testing could ever, or should ever, be policed for recreational climbers. Sponsored climbers or those who climb for status need to carefully consider both the medical and ethical implications if using drugs to aid performance. In some countries (e.g., Switzerland and Germany), administrative systems for mountaineering or medication control dictate a specific stance, but for most recreational mountaineers, any rules would be unenforceable and have to be a personal decision, but should take into account the current best evidence for risk, benefit, and sporting ethics.
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Affiliation(s)
- Enrico Donegani
- 1 Department of Cardiovascular Surgery, Sabah Al-Ahmed Cardiac Center , Al-Amiri Hospital, Kuwait, State of Kuwait
| | - Peter Paal
- 2 Department of Anaesthesiology and Critical Care Medicine, Innsbruck University Hospital , Innsbruck, Austria .,3 Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, United Kingdom .,4 Perioperative Medicine, St. Bartholomew's Hospital , London, United Kingdom
| | - Thomas Küpper
- 5 Institute of Occupational and Social Medicine, RWTH Aachen University , Aachen, Germany
| | - Urs Hefti
- 6 Department of Orthopedic and Trauma Surgery, Swiss Sportclinic , Bern, Switzerland
| | - Buddha Basnyat
- 7 Oxford University Clinical Research Unit-Nepal , Nepal International Clinic, and Himalayan Rescue, Kathmandu, Nepal
| | - Anna Carceller
- 8 Sports Medicine School, Instituto de Medicina de Montaña y del Deporte (IMMED), Federació d'Entitats Excursionistes (FEEC), University of Barcelona , Barcelona, Spain
| | - Pierre Bouzat
- 9 Department of Anesthesiology and Critical Care, University Hospital, INSERM U1236, Neuroscience Institute, Alps University, Grenoble, France
| | - Rianne van der Spek
- 10 Department of Endocrinology and Metabolism, Academic Medical Center Amsterdam, University of Amsterdam , Amsterdam, The Netherlands
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25
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Chan CW, Wang SH. Response to Letter by Gaurav Sikri and Srinivasa AB. J Travel Med 2016; 23:taw029. [PMID: 27178164 DOI: 10.1093/jtm/taw029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/14/2022]
Affiliation(s)
- Cheng-Wei Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Taiwan Wilderness Medical Association, Taipei, Taiwan
| | - Shih-Hao Wang
- Taiwan Wilderness Medical Association, Taipei, Taiwan, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi Taiwan and Altitude Research Center, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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26
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Rimoldi SF, Rexhaj E, Duplain H, Urben S, Billieux J, Allemann Y, Romero C, Ayaviri A, Salinas C, Villena M, Scherrer U, Sartori C. Acute and Chronic Altitude-Induced Cognitive Dysfunction in Children and Adolescents. J Pediatr 2016; 169:238-43. [PMID: 26541425 DOI: 10.1016/j.jpeds.2015.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/31/2015] [Accepted: 10/02/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess whether exposure to high altitude induces cognitive dysfunction in young healthy European children and adolescents during acute, short-term exposure to an altitude of 3450 m and in an age-matched European population permanently living at this altitude. STUDY DESIGN We tested executive function (inhibition, shifting, and working memory), memory (verbal, short-term visuospatial, and verbal episodic memory), and speed processing ability in: (1) 48 healthy nonacclimatized European children and adolescents, 24 hours after arrival at high altitude and 3 months after return to low altitude; (2) 21 matched European subjects permanently living at high altitude; and (3) a matched control group tested twice at low altitude. RESULTS Short-term hypoxia significantly impaired all but 2 (visuospatial memory and processing speed) of the neuropsychological abilities that were tested. These impairments were even more severe in the children permanently living at high altitude. Three months after return to low altitude, the neuropsychological performances significantly improved and were comparable with those observed in the control group tested only at low altitude. CONCLUSIONS Acute short-term exposure to an altitude at which major tourist destinations are located induces marked executive and memory deficits in healthy children. These deficits are equally marked or more severe in children permanently living at high altitude and are expected to impair their learning abilities.
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Affiliation(s)
- Stefano F Rimoldi
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland
| | - Emrush Rexhaj
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland
| | - Hervé Duplain
- Department of Internal Medicine, University Hospital, Lausanne, Switzerland
| | - Sébastien Urben
- Research Unit, Child and Adolescent Psychiatric Service, University Hospital, Lausanne, Switzerland
| | - Joël Billieux
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Yves Allemann
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland
| | | | | | - Carlos Salinas
- Bolivian Institute of Altitude Biology (IBBA), La Paz, Bolivia
| | | | - Urs Scherrer
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland; Department of Biology, University of Tarapacá, Arica, Chile
| | - Claudio Sartori
- Department of Internal Medicine, University Hospital, Lausanne, Switzerland.
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Joy E, Van Baak K, Dec KL, Semakula B, Cardin AD, Lemery J, Wortley GC, Yaron M, Madden C. Wilderness Preparticipation Evaluation and Considerations for Special Populations. Wilderness Environ Med 2015; 26:S76-91. [PMID: 26617382 DOI: 10.1016/j.wem.2015.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population- specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.
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Affiliation(s)
- Elizabeth Joy
- Clinical Outcomes Research, Intermountain Healthcare, Salt Lake City, Utah (Dr Joy).
| | - Karin Van Baak
- Department of Family Medicine, University of Colorado, Denver, Colorado (Dr Van Baak)
| | | | - Barbara Semakula
- Anne Arundel Medical Center, Orthopedic and Sports Medicine Center, Annapolis, Maryland (Dr Semakula)
| | - Ashlea D Cardin
- Missouri State University, Springfield, Missouri (Dr Cardin)
| | - Jay Lemery
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado (Drs Lemery and Yaron)
| | - George C Wortley
- Big Island Family Medicine Center, Lynchburg, Virginia (Dr Wortley)
| | - Michael Yaron
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado (Drs Lemery and Yaron)
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28
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Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thébaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL. Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society. Circulation 2015; 132:2037-99. [PMID: 26534956 DOI: 10.1161/cir.0000000000000329] [Citation(s) in RCA: 706] [Impact Index Per Article: 78.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension is associated with diverse cardiac, pulmonary, and systemic diseases in neonates, infants, and older children and contributes to significant morbidity and mortality. However, current approaches to caring for pediatric patients with pulmonary hypertension have been limited by the lack of consensus guidelines from experts in the field. In a joint effort from the American Heart Association and American Thoracic Society, a panel of experienced clinicians and clinician-scientists was assembled to review the current literature and to make recommendations on the diagnosis, evaluation, and treatment of pediatric pulmonary hypertension. This publication presents the results of extensive literature reviews, discussions, and formal scoring of recommendations for the care of children with pulmonary hypertension.
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MESH Headings
- Cardiovascular Agents/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy
- Diagnostic Imaging/methods
- Disease Management
- Extracorporeal Membrane Oxygenation
- Genetic Counseling
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Hernias, Diaphragmatic, Congenital/complications
- Hernias, Diaphragmatic, Congenital/therapy
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/genetics
- Hypertension, Pulmonary/therapy
- Infant
- Infant, Newborn
- Lung/embryology
- Lung Transplantation
- Nitric Oxide/administration & dosage
- Nitric Oxide/therapeutic use
- Oxygen Inhalation Therapy
- Persistent Fetal Circulation Syndrome/diagnosis
- Persistent Fetal Circulation Syndrome/therapy
- Postoperative Complications/therapy
- Respiration, Artificial/adverse effects
- Respiration, Artificial/methods
- Ventilator-Induced Lung Injury/prevention & control
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29
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Polli JB, Polli I. Traveling with children: beyond car seat safety. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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30
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Polli JB, Polli I. Traveling with children: beyond car seat safety. J Pediatr (Rio J) 2015; 91:515-22. [PMID: 26232504 DOI: 10.1016/j.jped.2015.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 04/27/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To spread knowledge and instigate the health professional to give advice on childcare during travels and on child transport safety. SOURCES OF DATA Literature review through the LILACS and MEDLINE(®) databases, using the terms: travel, safety, protective equipment, child, preventive medicine, retrieving articles published in the last 21 years. SUMMARY OF THE FINDINGS The authors analyzed 93 articles, of which 66 met the inclusion criteria after summaries were read. For drafting this article, the following sub-themes were proposed: getting ready to travel with children; knowing some of the transfer risks (air, land and water transportation) and exploring the destination with children (sun exposure, accommodations, altitude, food, traveler's diarrhea, insect bites) and return from the trip with children. CONCLUSIONS Over the years, there has been an increase in the number of children who travel around the world. However, this population is still subject to health problems while traveling and may be even more susceptible than the adult age group. These problems arise from a variety of factors, including exposure to infectious organisms, the use of certain types of transportation, and participation in some activities, such as hiking at high altitudes, among others. However, when traveling with children, these risk factors can be overlooked; a trip that is considered safe for an adult might not be a good choice for this age group. The pediatric consultation should be a good opportunity to optimize preventive guidelines at the pre-trip planning.
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Affiliation(s)
- Janaina Borges Polli
- Universidade de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| | - Ismael Polli
- Universidade de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Abstract
Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population-specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.
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32
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Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, Zafren K, Hackett PH. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med 2015; 25:S4-14. [PMID: 25498261 DOI: 10.1016/j.wem.2014.06.017] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022]
Abstract
To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146-155.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA (Drs Luks and Schoene).
| | | | - Colin K Grissom
- Pulmonary and Critical Care Division, Intermountain Medical Center and the University of Utah, Salt Lake City, UT (Dr Grissom)
| | - Paul S Auerbach
- Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Drs Auerbach and Zafren)
| | - George W Rodway
- Division of Health Sciences, University of Nevada, Reno, NV (Dr Rodway)
| | - Robert B Schoene
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA (Drs Luks and Schoene); East Bay Regional Pulmonary and Critical Care Medicine Associates, Berkeley, CA (Dr Schoene)
| | - Ken Zafren
- Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Drs Auerbach and Zafren); Himalayan Rescue Association, Kathmandu, Nepal (Dr Zafren)
| | - Peter H Hackett
- Division of Emergency Medicine, Altitude Research Center, University of Colorado School of Medicine, Aurora and the Institute for Altitude Medicine, Telluride, CO (Dr Hackett)
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33
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Wu SH, Lin YC, Weng YM, Chiu YH, Li WC, Wang SH, Chan CW, Chiu TF, Huang KF, Chen CH. The impact of physical fitness and body mass index in children on the development of acute mountain sickness: A prospective observational study. BMC Pediatr 2015; 15:55. [PMID: 25947200 PMCID: PMC4493965 DOI: 10.1186/s12887-015-0373-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 04/29/2015] [Indexed: 12/03/2022] Open
Abstract
Background Acute mountain sickness (AMS) is commonly found among people traveling above 2500 m. We investigated whether the occurrence of AMS is related to differences in individual physical fitness and BMI in subjects 11–13 years of age. Methods This study was conducted at Xue Mountain, Taiwan (elevation of 3886 m) between June 13, 2011 and June 17, 2011. Subjects were asked to ascend from Taipei City (25 m) to the summit (3886 m) over 3 days and 2 nights. Gender, age, weight, height, and fitness index (determined using a 3-minute step test) were recorded at sea level before ascent. The Lake Louise AMS score was used to record symptoms and diagnose AMS. Results A total of 179 subjects (mean age: 11.8 years; 102 males, 77 females) were included in the analysis. A total of 44.7% of subjects were diagnosed with AMS. Male gender (p = 0.004) and elevated body mass index (BMI) (p < 0.001) were each associated with the development of AMS. However the physical fitness index was comparable in subjects with and without AMS (67.8 ± 10.1 vs. 68.0 ± 9.3, p = 0.9). Conclusions This study shows that both BMI and male gender were associated with the development of AMS in 11–13 year old children. Physical fitness was not associated with the occurrence of AMS. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0373-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shih-Hao Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. .,Chang Gung University School of Medicine, Taoyuan, Taiwan.
| | - Yin-Chou Lin
- Chang Gung University School of Medicine, Taoyuan, Taiwan. .,Department of Physical and Rehabilitation Medicine, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan.
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. .,Chang Gung University School of Medicine, Taoyuan, Taiwan.
| | - Yu-Hui Chiu
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan. .,Institute of Environmental and Occupational Health Science, National Yang-Ming University, Taipei, Taiwan.
| | - Wen-Cheng Li
- Chang Gung University School of Medicine, Taoyuan, Taiwan. .,Department of Occupation Medicine, Chang-Gung Memorial Hospital at Keelung, Keelung, Taiwan. .,Department of Occupation Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| | - Shih-Hao Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan. .,Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan. .,Altitude Research Center, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. .,Taiwan Wilderness Medical Association, Taipei, Taiwan.
| | - Chang-Wei Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. .,Chang Gung University School of Medicine, Taoyuan, Taiwan.
| | - Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. .,Chang Gung University School of Medicine, Taoyuan, Taiwan.
| | - Kuo-Feng Huang
- Department of Physical Education, National Taitung University, Taitung, Taiwan. .,Department of Emergency Medicine, Taiwan Adventist Hospital, Taipei, Taiwan.
| | - Chung-Hsien Chen
- Chang Gung University School of Medicine, Taoyuan, Taiwan. .,Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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34
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Suchý J, Opočenský J. Usefulness of training camps at high altitude for well-trained adolescents. ACTA GYMNICA 2015. [DOI: 10.5507/ag.2015.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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35
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Hagmann SHF, Leshem E, Fischer PR, Stauffer WM, Barnett ED, Christenson JC. Preparing children for international travel: need for training and pediatric-focused research. J Travel Med 2014; 21:377-83. [PMID: 25158953 DOI: 10.1111/jtm.12155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/30/2014] [Accepted: 07/07/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The International Society of Travel Medicine (ISTM) Pediatric Interest Group (PedIG) was created in 2010. We studied the group's professional characteristics and practice patterns to identify clinical areas requiring further training and research related to pediatric international travel. METHODS PedIG members were emailed a two-part online questionnaire in September 2011, which comprised questions about professional and practice details, followed by a survey regarding decisions on nine patient scenarios that represent common pediatric pre-travel health challenges. RESULTS Ninety-three (34%) of 273 members completed the survey. Most were physicians (80%) having a primary specialization in pediatrics (55%) and family medicine (19%). About a third (37%) had acquired the ISTM Certificate in Travel Health (CTH); 14 and 11% chose not to provide malaria chemoprophylaxis for a 2-month-old infant and a 13-year-old child traveling to West Africa, respectively. Azithromycin for empiric treatment of travelers' diarrhea in a 2-year-old traveler to Thailand and Mexico was suggested by 74 and 58%, respectively, while the use of acetazolamide for a 2-month old infant traveling to a high-altitude destination was rarely (13%) chosen. In vaccine-focused scenarios, 71, 69, 21, and 10% would prescribe the meningococcal vaccine for a 6-month-old traveler to Burkina Faso, Japanese encephalitis vaccine to a 10-year-old traveler to Cambodia, hepatitis A vaccine to a 6-month-old traveler to El Salvador, and the typhoid vaccine to a 1-year-old traveler to India, respectively. CONCLUSIONS Members of the PedIG have diverse professional and practice backgrounds. Lack of awareness of established guidelines may place international pediatric travelers at risk for travel-associated morbidity. Strategies are needed to facilitate education and support research in pediatric travel medicine to formulate evidence-based guidelines wherever they are currently missing.
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Affiliation(s)
- Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY, USA
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36
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De A, Davidson Ward SL. Syncope at altitude: an enigmatic case. Pediatr Pulmonol 2014; 49:E144-6. [PMID: 24863103 DOI: 10.1002/ppul.23062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/13/2014] [Indexed: 12/20/2022]
Abstract
We report a case of a young boy with recurrent episodes of syncope at elevated altitude. While not conforming to common presentations of altitude sickness, the differential diagnoses and possible etiologies are discussed.
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Affiliation(s)
- Aliva De
- Division of Pediatric Pulmonology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
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37
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Mateu P, Kostusiak V, Breton O. Effets physiologiques de la haute altitude chez l’adolescent pendant une expédition au Kun 7087m. Sci Sports 2014. [DOI: 10.1016/j.scispo.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Kriemler S, Bürgi F, Wick C, Wick B, Keller M, Wiget U, Schindler C, Kaufmann BA, Kohler M, Bloch K, Brunner-La Rocca HP. Prevalence of Acute Mountain Sickness at 3500 m Within and Between Families: A Prospective Cohort Study. High Alt Med Biol 2014; 15:28-38. [DOI: 10.1089/ham.2013.1073] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Susi Kriemler
- Institute of Social and Preventive Medicine, University of Zürich, Zurich, Switzerland
| | - Flavia Bürgi
- Institute of Social and Preventive Medicine, University of Zürich, Zurich, Switzerland
| | - Christian Wick
- Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland
| | - Birgit Wick
- Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland
| | - Melanie Keller
- Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland
| | - Urs Wiget
- Swiss Society for Emergency Medicine, Bern, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Beat A. Kaufmann
- Division of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Malcolm Kohler
- Pulmonary Division, University Hospital Zürich, Zurich, Switzerland
| | - Konrad Bloch
- Pulmonary Division, University Hospital Zürich, Zurich, Switzerland
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39
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Zafren K. Prevention of high altitude illness. Travel Med Infect Dis 2014; 12:29-39. [DOI: 10.1016/j.tmaid.2013.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/05/2013] [Accepted: 12/10/2013] [Indexed: 11/28/2022]
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40
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Bates ML, Pillers DAM, Palta M, Farrell ET, Eldridge MW. Ventilatory control in infants, children, and adults with bronchopulmonary dysplasia. Respir Physiol Neurobiol 2013; 189:329-37. [PMID: 23886637 DOI: 10.1016/j.resp.2013.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/16/2013] [Accepted: 07/16/2013] [Indexed: 12/17/2022]
Abstract
Bronchopulmonary dysplasia (BPD), or chronic lung disease of prematurity, occurs in ~30% of preterm infants (15,000 per year) and is associated with a clinical history of mechanical ventilation and/or high inspired oxygen at birth. Here, we describe changes in ventilatory control that exist in patients with BPD, including alterations in chemoreceptor function, respiratory muscle function, and suprapontine control. Because dysfunction in ventilatory control frequently revealed when O2 supply and CO2 elimination are challenged, we provide this information in the context of four important metabolic stressors: stresses: exercise, sleep, hypoxia, and lung disease, with a primary focus on studies of human infants, children, and adults. As a secondary goal, we also identify three key areas of future research and describe the benefits and challenges of longitudinal human studies using well-defined patient cohorts.
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Affiliation(s)
- Melissa L Bates
- Department of Pediatrics, Division of Critical Care, University of Wisconsin, Madison, WI, USA; John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin, Madison, WI, USA.
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41
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Allemann Y, Stuber T, de Marchi SF, Rexhaj E, Sartori C, Scherrer U, Rimoldi SF. Pulmonary artery pressure and cardiac function in children and adolescents after rapid ascent to 3,450 m. Am J Physiol Heart Circ Physiol 2012; 302:H2646-53. [PMID: 22523248 DOI: 10.1152/ajpheart.00053.2012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
High-altitude destinations are visited by increasing numbers of children and adolescents. High-altitude hypoxia triggers pulmonary hypertension that in turn may have adverse effects on cardiac function and may induce life-threatening high-altitude pulmonary edema (HAPE), but there are limited data in this young population. We, therefore, assessed in 118 nonacclimatized healthy children and adolescents (mean ± SD; age: 11 ± 2 yr) the effects of rapid ascent to high altitude on pulmonary artery pressure and right and left ventricular function by echocardiography. Pulmonary artery pressure was estimated by measuring the systolic right ventricular to right atrial pressure gradient. The echocardiography was performed at low altitude and 40 h after rapid ascent to 3,450 m. Pulmonary artery pressure was more than twofold higher at high than at low altitude (35 ± 11 vs. 16 ± 3 mmHg; P < 0.0001), and there existed a wide variability of pulmonary artery pressure at high altitude with an estimated upper 95% limit of 52 mmHg. Moreover, pulmonary artery pressure and its altitude-induced increase were inversely related to age, resulting in an almost twofold larger increase in the 6- to 9- than in the 14- to 16-yr-old participants (24 ± 12 vs. 13 ± 8 mmHg; P = 0.004). Even in children with the most severe altitude-induced pulmonary hypertension, right ventricular systolic function did not decrease, but increased, and none of the children developed HAPE. HAPE appears to be a rare event in this young population after rapid ascent to this altitude at which major tourist destinations are located.
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Affiliation(s)
- Yves Allemann
- Department of Cardiology, Inselspital, University Hospital, Bern, Switzerland
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Dallimore J, Foley JA, Valentine P. Background Rates of Acute Mountain Sickness-Like Symptoms at Low Altitude in Adolescents Using Lake Louise Score. Wilderness Environ Med 2012; 23:11-4. [DOI: 10.1016/j.wem.2011.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/10/2011] [Accepted: 10/06/2011] [Indexed: 12/01/2022]
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Abstract
In infants and children with chronic respiratory disease, hypoxia is a potential risk of aircraft travel. Although guidelines have been published to assist clinicians in assessing an individual's fitness to fly, they are not wholly evidence based. In addition, most evidence relates to adults with chronic obstructive pulmonary disease and thus cannot be extrapolated to children and infants. This review summarises the current literature as it applies to infants and children potentially at risk during air travel. Current evidence suggests that the gold standard for assessing fitness to fly, the hypoxia flight simulation test, may not be accurate in predicting in flight hypoxia in infants and children with respiratory disease. Further research is needed to determine the best methods of assessing safety of flight in infants and children.
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Affiliation(s)
- Adelaide Withers
- Respiratory Medicine, Princess Margaret Hospital, Perth, Australia.
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44
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Abstract
High-altitude illnesses encompass the pulmonary and cerebral syndromes that occur in non-acclimatized individuals after rapid ascent to high altitude. The most common syndrome is acute mountain sickness (AMS) which usually begins within a few hours of ascent and typically consists of headache variably accompanied by loss of appetite, nausea, vomiting, disturbed sleep, fatigue, and dizziness. With millions of travelers journeying to high altitudes every year and sleeping above 2,500 m, acute mountain sickness is a wide-spread clinical condition. Risk factors include home elevation, maximum altitude, sleeping altitude, rate of ascent, latitude, age, gender, physical condition, intensity of exercise, pre-acclimatization, genetic make-up, and pre-existing diseases. At higher altitudes, sleep disturbances may become more profound, mental performance is impaired, and weight loss may occur. If ascent is rapid, acetazolamide can reduce the risk of developing AMS, although a number of high-altitude travelers taking acetazolamide will still develop symptoms. Ibuprofen can be effective for headache. Symptoms can be rapidly relieved by descent, and descent is mandatory, if at all possible, for the management of the potentially fatal syndromes of high-altitude pulmonary and cerebral edema. The purpose of this review is to combine a discussion of specific risk factors, prevention, and treatment options with a summary of the basic physiologic responses to the hypoxia of altitude to provide a context for managing high-altitude illnesses and advising the non-acclimatized high-altitude traveler.
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Kuhn S, Hui C. STATEMENT ON PEDIATRIC TRAVELLERS: Committee to Advise on Tropical Medicine and Travel. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2010; 36:1-31. [PMID: 31701957 PMCID: PMC6802455 DOI: 10.14745/ccdr.v36i00a03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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46
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Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, Zafren K, Hackett PH. Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness. Wilderness Environ Med 2010; 21:146-55. [PMID: 20591379 DOI: 10.1016/j.wem.2010.03.002] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 10/18/2022]
Abstract
To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the prevention and treatment of acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations for their roles in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to the prevention and management of each disorder that incorporate these recommendations.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA.
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47
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Pradhan S, Yadav S, Neupane P, Subedi P. Acute Mountain Sickness in Children at 4380 Meters in the Himalayas. Wilderness Environ Med 2009; 20:359-63. [DOI: 10.1580/1080-6032-020.004.0359] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Abstract
Cellular hypoxia is the common final pathway of brain injury that occurs not just after asphyxia, but also when cerebral perfusion is impaired directly (eg, embolic stroke) or indirectly (eg, raised intracranial pressure after head injury). We Review recent advances in the understanding of neurological clinical syndromes that occur on exposure to high altitudes, including high altitude headache (HAH), acute mountain sickness (AMS), and high altitude cerebral oedema (HACE), and the genetics, molecular mechanisms, and physiology that underpin them. We also present the vasogenic and cytotoxic bases for HACE and explore venous hypertension as a possible contributory factor. Although the factors that control susceptibility to HACE are poorly understood, the effects of exposure to altitude (and thus hypobaric hypoxia) might provide a reproducible model for the study of cerebral cellular hypoxia in healthy individuals. The effects of hypobaric hypoxia might also provide new insights into the understanding of hypoxia in the clinical setting.
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Affiliation(s)
- Mark H Wilson
- Centre for Altitude, Space and Extreme Environment Medicine, University College London, London, UK.
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49
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Jean D. L’enfant en montagne : dangers de l’altitude, du froid et du soleil. ACTUALITES PHARMACEUTIQUES 2009. [DOI: 10.1016/s0515-3700(09)70044-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Bloch J, Duplain H, Rimoldi SF, Stuber T, Kriemler S, Allemann Y, Sartori C, Scherrer U. Prevalence and time course of acute mountain sickness in older children and adolescents after rapid ascent to 3450 meters. Pediatrics 2009; 123:1-5. [PMID: 19117853 DOI: 10.1542/peds.2008-0200] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Acute mountain sickness is a frequent and debilitating complication of high-altitude exposure, but there is little information on the prevalence and time course of acute mountain sickness in children and adolescents after rapid ascent by mechanical transportation to 3500 m, an altitude at which major tourist destinations are located throughout the world. METHODS We performed serial assessments of acute mountain sickness (Lake Louise scores) in 48 healthy nonacclimatized children and adolescents (mean +/- SD age: 13.7 +/- 0.3 years; 20 girls and 28 boys), with no previous high-altitude experience, 6, 18, and 42 hours after arrival at the Jungfraujoch high-altitude research station (3450 m), which was reached through a 2.5-hour train ascent. RESULTS We found that the overall prevalence of acute mountain sickness during the first 3 days at high altitude was 37.5%. Rates were similar for the 2 genders and decreased progressively during the stay (25% at 6 hours, 21% at 18 hours, and 8% at 42 hours). None of the subjects needed to be evacuated to lower altitude. Five subjects needed symptomatic treatment and responded well. CONCLUSION After rapid ascent to high altitude, the prevalence of acute mountain sickness in children and adolescents was relatively low; the clinical manifestations were benign and resolved rapidly. These findings suggest that, for the majority of healthy nonacclimatized children and adolescents, travel to 3500 m is safe and pharmacologic prophylaxis for acute mountain sickness is not needed.
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Affiliation(s)
- Jonathan Bloch
- Botnar Center for Extreme Medicine, Department of Internal Medicine, University Hospital, Lausanne, Switzerland
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