Diagnosis Of High Altitude Pulmonary Edema Research Articles

Chest pain in six Taiwanese teenagers at high altitudes.

There is scant literature to date about the application of point-of-care devices for diagnosis of high-altitude pulmonary edema and clinical management in symptomatic teenagers. Hence, we characterized the early changes in point-of-care assessments to gain a deeper insight into the physiological responses in teenagers during a 3-day trek.

MIR17HG polymorphisms contribute to high-altitude pulmonary edema susceptibility in the Chinese population

High-altitude pulmonary edema (HAPE) is a common acute altitude sickness. This study was designed to investigate the effect of MIR17HG polymorphisms on HAPE risk in the Chinese population. The Agena MassARRAY platform was used to genotype six single-nucleotide polymorphisms (SNPs) in the MIR17HG gene in 244 HAPE patients and 243 non-HAPE controls. The odds ratio (OR) and 95% confidence interval were used to evaluate the association between each MIR17HG polymorphisms and the risk of HAPE under a polygenetic model. Statistical analysis was performed using the χ2 test. Multifactor dimensionality reduction (MDR) analysis was used to analyze the impacts of SNP–SNP interactions on the risk of HAPE. According to the allele model, the HAPE risk of people with the rs7318578 A allele of MIR17HG was lower than that of people with the C allele (OR 0.74, p = 0.036).Logistic regression analysis of four models for all selected MIR17HG SNPs showed significant differences in the frequencies of rs7318578 (OR 0.74, p = 0.037) and rs17735387 (OR 1.51, p = 0.036) between cases and controls. The results of the sex stratification analysis showed that among males, rs17735387 in the MIR17HG gene is associated with an increased risk of HAPE. MDR analysis showed that the best combination model was a three-locus model incorporating rs72640334, rs7318578, and rs7336610. This study revealed the correlations between rs7318578 and rs17735387 on the MIR17HG gene and the risk of HAPE in the Chinese population, providing a theoretical basis for the early screening, prevention, and diagnosis of HAPE in high-risk populations.

Role of point-of-care ultrasound in grading the severity and early diagnosis of high-altitude pulmonary edema at a peripheral hospital

Background and Aims: Troops deployed at high-altitude area (HAA) suffer from various high-altitude illnesses (HAIs) including high-altitude pulmonary edema (HAPE). There are various criteria to diagnose and assess the severity of HAPE, but point-of-care ultrasound (POCUS) of the lung has also been used in isolation by physicians. The aim is to assess whether POCUS of the lung improves the ability to diagnose the severity of HAPE. Methodology: A retrospective, cross-sectional descriptive study was planned for the patients treated for HAPE (n = 46) at our hospital from January 2019 to March 2020. Prehospital admission data, hospital admission data, and discharge data for the first-time inductees and reinductees were collected from the central hospital admission registry and central database of the medical department and intensive care unit. Results: The incidence of HAPE was 2.2 per 1000. First-time inductees (n = 30) were affected more when compared to reinductees (n = 16) and the maximum were at the third stage of HAA. POCUS of the lung facilitated the diagnosis of the six patients with mild HAPE with no positive radiological features. Conclusions: POCUS of the lung should be routinely used by the medical officers deployed at high altitudes. It will increase the diagnostic rate of HAPE with meticulous grading of the severity, thereby aiding in formulating the case-specific treatment protocol.

High-Altitude Pulmonary Edema and Patent Foramen Ovale

To the Editor: In their case-control study, Dr Allemann and colleagues identified an association between patent foramen ovale (PFO) and susceptibility to high-altitude pulmonary edema (HAPE) in mountaineers. In HAPEsusceptible participants, they observed low arterial oxygen saturation that preceded the onset of clinical HAPE. Their study suggests that intracardiac right-to-left shunting through a PFO is partly responsible for this hypoxemia. We believe that subclinical pulmonary edema may also contribute to the early hypoxemia observed in this group and suggest a means of evaluating this in future studies. The ascent to Capanna Regina Margherita induces subclinical pulmonary edema, even in those persons not developing clinical HAPE. Allemann et al describe no attempt to determine the degree of pulmonary edema present when their participants’ oxygen saturations were measured. Persons who subsequently developed clinical HAPE may have already incurred significant, if subclinical, pulmonary edema when their oxygen saturations were measured. Correspondingly, a portion of the exaggerated hypoxemia noted in HAPE-susceptible individuals who did not progress to clinical HAPE may share a similar etiology. Chest radiography was only performed at the study’s conclusion to confirm or exclude the diagnosis of HAPE and is relatively insensitive for identifying the early pulmonary edema that precedes clinical HAPE. Given this, even if radiography had been used to assess for pulmonary edema at the time oxygen saturations were measured, it might not have proven useful. As an alternative, chest ultrasonography may be more helpful to quantify pulmonary edema. The comet-tail technique of chest ultrasonography has been correlated with radiographic and thermodilution measures of pulmonary edema. The technique does not require equipment beyond the transthoracic ultrasound equipment usually used for monitoring pulmonary artery pressures in HAPE research. It may help distinguish the relative contributions of edema and intracardiac shunting to the hypoxemia present before and during clinical HAPE.

Diagnosis:

The diagnosis of high-altitude pulmonary edema (HAPE) was made by history, examination, and the typical radiographic appearance of high-altitude pulmonary edema. Note the patchy infiltrates concentrated in the right mid-lung field, with sparing of the apices and supra-diaphragmatic regions, as well as the normal heart size.