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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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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: 17] [Impact Index Per Article: 3.4] [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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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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Luks AM. Do we have a "best practice" for treating high altitude pulmonary edema? High Alt Med Biol 2008; 9:111-4. [PMID: 18578641 DOI: 10.1089/ham.2008.1017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
High-altitude pulmonary edema (HAPE) is a rare, but potentially fatal, non-cardiogenic pulmonary edema that affects unacclimatized lowlanders ascending to altitudes above 2500 m. A review of the literature on the disease suggests that a wide range of strategies is employed for treatment purposes. This situation raises questions as to whether a "best practice" exists for treating HAPE and whether clinicians are using greater measures than necessary to ensure good outcomes. This review considers these issues in greater detail, examining the current state of research and clinical practice in HAPE treatment, addressing important questions raised by documented treatment practices, such as the utility of beta agonists, acetazolamide and diuretics and, finally, proposing reasonable, parsimonious treatment approaches that reflect the setting in which the patient is being treated.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington 91895-6522, USA.
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Krissoff WB, Eiseman B. The Hazards of Exercising at Altitude. PHYSICIAN SPORTSMED 1975; 3:26-31. [PMID: 29281471 DOI: 10.1080/00913847.1975.11948238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sutton J. ACUTE MOUNTAIN SICKNESS: AN HISTORICAL REVIEW, WITH SOME EXPERIENCES FROM THE PERUVIAN ANDES. Med J Aust 1971. [DOI: 10.5694/j.1326-5377.1971.tb50532.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John Sutton
- Garvan Institute, St Vincent's Hospital Sydney
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