scholarly journals Evaluation of High Altitude Interstitial Pulmonary Edema in Healthy Participants Using Rapid 4-View Lung Ultrasound Protocol During Staged Ascent to Everest Base Camp

2021 ◽  
Author(s):  
Craig D. Nowadly ◽  
Kenneth M. Kelley ◽  
Desiree H. Crane ◽  
John S. Rose
Keyword(s):  
Pulmonary Edema ◽  
High Altitude ◽  
Lung Ultrasound ◽  
Base Camp ◽  
Interstitial Pulmonary Edema ◽  
Healthy Participants

scholarly journals Airway responses to methacholine and exercise at high altitude in healthy lowlanders

2010 ◽  
Vol 108 (2) ◽  
pp. 256-265 ◽  
Author(s):  
Riccardo Pellegrino ◽  
Pasquale Pompilio ◽  
Marco Quaranta ◽  
Andrea Aliverti ◽  
Bengt Kayser ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
High Altitude ◽  
Sea Level ◽  
Minute Ventilation ◽  
Lung Mechanics ◽  
Respiratory Resistance ◽  
Interstitial Pulmonary Edema ◽  
Forced Expiratory Flow ◽  
Expiratory Flow ◽  
Airway Responses

Peribronchial edema has been proposed as a mechanism enhancing airway responses to constrictor stimuli. Acute exposure to altitude in nonacclimatized lowlanders leads to subclinical interstitial pulmonary edema that lasts for several days after ascent, as suggested by changes in lung mechanics. We, therefore, investigated whether changes in lung mechanics consistent with fluid accumulation at high altitude within the lungs are associated with changes in airway responses to methacholine or exercise. Fourteen healthy subjects were studied at 4,559 and at 120 m above sea level. At high altitude, both static and dynamic lung compliances and respiratory reactance at 5 Hz significantly decreased, suggestive of interstitial pulmonary edema. Resting minute ventilation significantly increased by ∼30%. Compared with sea level, inhalation of methacholine at high altitude caused a similar reduction of partial forced expiratory flow but less reduction of maximal forced expiratory flow, less increments of pulmonary resistance and respiratory resistance at 5 Hz, and similar effects of deep breath on pulmonary and respiratory resistance. During maximal incremental exercise at high altitude, partial forced expiratory flow gradually increased with the increase in minute ventilation similarly to sea level but both achieved higher values at peak exercise. In conclusion, airway responsiveness to methacholine at high altitude is well preserved despite the occurrence of interstitial pulmonary edema. We suggest that this may be the result of the increase in resting minute ventilation opposing the effects and/or the development of airway smooth muscle force, reduced gas density, and well preserved airway-to-parenchyma interdependence.

Bolus intravenous 0.9% saline, but not 4% albumin or 5% glucose, causes interstitial pulmonary edema in healthy subjects

2015 ◽  
Vol 119 (7) ◽  
pp. 783-792 ◽  
Author(s):  
Shailesh Bihari ◽  
Ubbo F. Wiersema ◽  
David Schembri ◽  
Carmine G. De Pasquale ◽  
Dani-Louise Dixon ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Blood Volume ◽  
Doppler Echocardiography ◽  
Healthy Subjects ◽  
Lung Ultrasound ◽  
Fluid Administration ◽  
Edema Formation ◽  
Fluid Filtration ◽  
Lung Volumes ◽  
Interstitial Pulmonary Edema

Rapid intravenous (iv) infusion of 0.9% saline alters respiratory mechanics in healthy subjects. However, the relative cardiovascular and respiratory effects of bolus iv crystalloid vs. colloid are unknown. Six healthy male volunteers were given 30 ml/kg iv 0.9% saline, 4% albumin, and 5% glucose at a rate of 100 ml/min on 3 separate days in a double-blinded, randomized crossover study. Impulse oscillometry, spirometry, lung volumes, diffusing capacity (DLCO), and blood samples were measured before and after fluid administration. Lung ultrasound B-line score (indicating interstitial pulmonary edema) and Doppler echocardiography indices of cardiac preload were measured before, midway, immediately after, and 1 h after fluid administration. Infusion of 0.9% saline increased small airway resistance at 5 Hz ( P = 0.04) and lung ultrasound B-line score ( P = 0.01) without changes in Doppler echocardiography measures of preload. In contrast, 4% albumin increased DLCO, decreased lung volumes, and increased the Doppler echocardiography mitral E velocity ( P = 0.001) and E-to-lateral/septal e′ ratio, estimated blood volume, and N-terminal pro B-type natriuretic peptide ( P = 0.01) but not lung ultrasound B-line score, consistent with increased pulmonary blood volume without interstitial pulmonary edema. There were no significant changes with 5% glucose. Plasma angiopoietin-2 concentration increased only after 0.9% saline ( P = 0.001), suggesting an inflammatory mechanism associated with edema formation. In healthy subjects, 0.9% saline and 4% albumin have differential pulmonary effects not attributable to passive fluid filtration. This may reflect either different effects of these fluids on active signaling in the pulmonary circulation or a protective effect of albumin.

New Drugs Scale High-Altitude Pulmonary Edema

2005 ◽  
Vol 38 (19) ◽  
pp. 14
Author(s):  
BRUCE JANCIN
Keyword(s):  
Pulmonary Edema ◽  
High Altitude ◽  
New Drugs ◽  
High Altitude Pulmonary Edema

scholarly journals The Oxygen Transport Triad in High-Altitude Pulmonary Edema: A Perspective from the High Andes

2021 ◽  
Vol 18 (14) ◽  
pp. 7619
Author(s):  
Gustavo Zubieta-Calleja ◽  
Natalia Zubieta-DeUrioste
Keyword(s):  
Pulmonary Edema ◽  
High Altitude ◽  
Oxygen Transport ◽  
Acute Mountain Sickness ◽  
Breath Holding ◽  
Acid Base Balance ◽  
Initial Exposure ◽  
High Altitude Pulmonary Edema ◽  
Tolerance To Hypoxia ◽  
Dynamic Pump

Acute high-altitude illnesses are of great concern for physicians and people traveling to high altitude. Our recent article “Acute Mountain Sickness, High-Altitude Pulmonary Edema and High-Altitude Cerebral Edema, a View from the High Andes” was questioned by some sea-level high-altitude experts. As a result of this, we answer some observations and further explain our opinion on these diseases. High-Altitude Pulmonary Edema (HAPE) can be better understood through the Oxygen Transport Triad, which involves the pneumo-dynamic pump (ventilation), the hemo-dynamic pump (heart and circulation), and hemoglobin. The two pumps are the first physiologic response upon initial exposure to hypobaric hypoxia. Hemoglobin is the balancing energy-saving time-evolving equilibrating factor. The acid-base balance must be adequately interpreted using the high-altitude Van Slyke correction factors. Pulse-oximetry measurements during breath-holding at high altitude allow for the evaluation of high altitude diseases. The Tolerance to Hypoxia Formula shows that, paradoxically, the higher the altitude, the more tolerance to hypoxia. In order to survive, all organisms adapt physiologically and optimally to the high-altitude environment, and there cannot be any “loss of adaptation”. A favorable evolution in HAPE and pulmonary hypertension can result from the oxygen treatment along with other measures.

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