Treatment of High Altitude Pulmonary Edema at 4240 m in Nepal

ABSTRACT

Fagenholz, Peter J., Jonathan A. Gutman, Alice F. Murray, and N. Stuart Harris. Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Alt. Med. Biol. 8:139–146, 2007.—High altitude pulmonary edema (HAPE) is the leading cause of death from altitude illness and rapid descent is often considered a life-saving foundation of therapy. Nevertheless, in the remote settings where HAPE often occurs, immediate descent sometimes places the victim and rescuers at risk. We treated 11 patients (7 Nepalese, 4 foreigners) for HAPE at the Himalayan Rescue Association clinic in Pheriche, Nepal (4240 m), from March 3 to May 14, 2006. Ten were admitted and primarily treated there. Seven of these (6 Nepalese, 1 foreigner) had serious to severe HAPE (Hultgren grades 3 or 4). Bed rest, oxygen, nifedipine, and acetazolamide were used for all patients. Sildenafil and salmeterol were used in most, but not all patients. The duration of stay was 31 ± 16 h (range 12 to 48 h). Oxygen saturation was improved at discharge (84% ± 1.7%) compared with admission (59% ± 11%), as was ultrasound comet-tail score (11 ± 4 at discharge vs. 33 ± 8.6 at admission), a measure of pulmonary edema for which admission and discharge values were obtained in 7 patients. We conclude it is possible to treat even serious HAPE at 4240 m and discuss the significance of the predominance of Nepali patients seen in this series.