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. 2019 Jun;149(6):778-782.
doi: 10.4103/ijmr.IJMR_1981_17.

High-altitude pulmonary oedema: Newer treatment modalities for an age-old problem

Uday Yanamandra  1 , Manisha Sharma  2 , Deeksha Katoch  3 , Sushma Yanamandra  1 , Srinivasa A Bhattachar  4 , Amul Gupta  5 , Sagarika Patyal  6 , Rajan Grewal  6 , Suman Kumar  7 , Velu Nair  8
Affiliations

High-altitude pulmonary oedema: Newer treatment modalities for an age-old problem

Uday Yanamandra et al. Indian J Med Res. 2019 Jun.

Abstract

Background & objectives: High-altitude pulmonary oedema (HAPE) continues to challenge the healthcare providers at remote, resource-constrained settings. High-altitude terrain itself precludes convenience of resources. This study was conducted to evaluate the rise in peripheral capillary saturation of oxygen (SpO2) by the use of a partial rebreathing mask (PRM) in comparison to Hudson's mask among patients with HAPE.

Methods: This was a single-centre, randomized crossover study to determine the efficiency of PRM in comparison to Hudson's mask. A total of 88 patients with HAPE referred to a secondary healthcare facility at an altitude of 11,500 feet from January to October 2013 were studied. A crossover after adequate wash-out on both modalities was conducted for first two days of hospital admission. All patients with HAPE were managed with bed rest and stand-alone oxygen supplementation with no adjuvant pharmacotherapy.

Results: The mean SpO2on ambient air on arrival was 66.92±10.8 per cent for all patients with HAPE. Higher SpO2values were achieved with PRM in comparison to Hudson's mask on day one (86.08±5.15 vs. 77.23±9.09%) and day two (89.94±2.96 vs. 83.39±5.93%). The difference was more pronounced on day one as compared to day two.

Interpretation & conclusions: Mean SpO2values were found to be significantly higher among HAPE patients using PRM compared to those on Hudson's mask. Further studies to understand the translation of this incremental response in SpO2to clinical benefits (recovery times, mortality rates and hospital stay) need to be undertaken.

Keywords: Environmental illness; high-altitude pulmonary oedema; occupational health; oxygen delivery systems; oxygen therapy.

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Conflict of interest statement

None

Figures

Fig. 1
Fig. 1
Consort diagram and crossover design of the study. HAPE, high-altitude pulmonary oedema; HACE, high-altitude cerebral oedema; PRM, partial rebreathing mask; HTN, hypertension; DM, diabetes mellitus.
Fig. 2
Fig. 2
Boxer plot with different oxygen delivery systems on days one and two. Square dots with bars, Mean with 95% confidence interval. SpO2, Peripheral capillary oxygen saturation; Ambair, ambient air; Hudson's, Hudson's mask; PRM, partial rebreathing mask.
Fig. 3
Fig. 3
Bland-Altman analysis for Hudson's mask versus partial rebreathing mask (PRM).
See this image and copyright information in PMC

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Supplementary concepts