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ORIGINAL ARTICLE
Year : 2019  |  Volume : 149  |  Issue : 6  |  Page : 778-782

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


1 Department of Medicine, High Altitude Medical Research Centre, Leh, Ladakh, India
2 Military Nursing Services, Integrated HQ, Ministry of Defence, New Delhi, India
3 Station Medicare Centre, Air Force Station, Vadodara, India
4 Department of Physiology, High Altitude Medical Research Centre, Leh, Ladakh, India
5 Department of Radiology, High Altitude Medical Research Centre, Leh, Ladakh, India
6 Department of 153 General Hospital, High Altitude Medical Research Centre, Leh, Ladakh, India
7 Department of Hematology, Army Research & Referral Hospital, New Delhi, India
8 Department of Medicine, Armed Forces Medical College, Pune, India

Correspondence Address:
Dr Suman Kumar
Department of Hematology, Army Research & Referral Hospital, New Delhi 110 010
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1981_17

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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.


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