HIGH-ALTITUDE PULMONARY OEDEMA: NEWER TREATMENT MODALITIES FOR AN AGE-OLD PROBLEM

Background & objectives: High-altitude pulmonary oedema (HAPE) poses a challenge to the healthcare providers in remote mountainous areas, low resource settings. Mountain terrain with high-altitudes has low convenience of resources. We conducted the study to evaluate the rise in peripheral capillary saturation of oxygen (SpO2) by using a partial rebreathing mask (PRM) in comparison to Hudson’s mask among patients with HAPE. Methods: This was a randomized single cantered, crossover study which was conducted to determine the efficiency of PRM in comparison to Hudson’s mask. 88 total patients with HAPE were included in the study, 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 SpO2 on ambient air on arrival was 66.92±10.8 per cent for all patients with HAPE. Higher SpO2 values 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 SpO2 values 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 SpO2 to clinical benefits (recovery times, mortality rates and hospital stay) need to be undertaken. Key words Environmental illness - high-altitude pulmonary oedema - occupational health - oxygen delivery systems - oxygen therap