Prevention and treatment of high altitude cerebral edema (HACE)
DOI:
https://doi.org/10.12775/JEHS.2020.10.02.016Keywords
high altitude cerebral edema, HACE, prevention, treatmentAbstract
High altitude cerebral edema (HACE) is often a severe and potentially fatal manifestation of acute mountain sickness (AMS). It usually develops within the first 2 in individuals rapidly ascending at altitudes above 4000 m. The main cause of HACE is hypoxia, because of reduced oxygen level at high altitude.
The aim of this study was to to assess the methods of prevention and treatment of high altitude cerebral edema (HACE). Our study material consisted of publications, which were found in PubMed, ResearchGate and Google Scholar databases. The first step was to find proper publications from the last 30 years. The second step was to carry out an overview of the found publications.
Methods of prevention of acute mountain sickness are highly effective in high altitude cerebral edema prevention. Many studies estabilished the role of gradual ascent and staged ascent as well as administration of acetazolamide and dexamethasone in AMS prevention, and therefore in HACE prevention. Methods of treatments of acute mountain sickness are highly effective in high altitude cerebral edema treatment. Several researches proved the role of descent, administration of acetazolamide and dexamethasone, oxygen therapy as well as use of portable hyperbaric chamber in AMS treatment, and therefore in HACE treatment. However HACE treatment requires greater descent and larger doses of dexamethasone. Also duration of recovery is longer.
References
Hackett PH, Roach RC. High-altitude illness. N. Engl. J. Med. 2001; 345: 107–14.
Hackett P.H., Roach R.C. High altitude cerebral edema. High Altitude Medicine & Biology 2004;5(2):136‐46.
Luks A.M., Auerbach P.S., Freer L., Grissom C.K., Keyes L.E., Intosh M.C. et al. Wilderness Medical Society Practice Guidelines for the prevention and treatment of acute altitude illness: 2019 update. Wilderness Environ Med. 2019; 30: S3–S18.
Bloch, K.E., Turk, A.J.,,3 Maggiorini, M., Hess, T., Merz, T., Bosch, M.M. et al. Effect of ascent protocol on acute mountain sickness and success at Muztagh Ata, 7546 m. High Alt Med Biol. 2009; 10: 25–32
Beidleman, B.A., Fulco, C.S., Muza, S.R., Rock, P.B., Staab, J.E., Forte, V.A. et al. Effect of six days of staging on physiologic adjustments and acute mountain sickness during ascent to 4300 meters. High Alt Med Biol. 2009; 10: 253–260
Baggish, A.L., Fulco, C.S., Muza, S., Rock, P.B., Beidleman, B., Cymerman, A. et al. The impact of moderate-altitude staging on pulmonary arterial hemodynamics after ascent to high altitude. High Alt Med Biol. 2010; 11: 139–145
Forwand, S.A., Landowne, M., Follansbee, J.N., and Hansen, J.E. Effect of acetazolamide on acute mountain sickness. N Engl J Med. 1968; 279: 839–845
van Patot, M.C., Leadbetter, G. 3rd, Keyes, L.E., Maakestad, K.M., Olson, S., and Hackett, P.H. Prophylactic low-dose acetazolamide reduces the incidence and severity of acute mountain sickness. High Alt Med Biol. 2008; 9: 289–293
Gertsch, J.H., Basnyat, B., Johnson, E.W., Onopa, J., and Holck, P.S. Randomised, double blind, placebo controlled comparison of Ginkgo biloba and acetazolamide for prevention of acute mountain sickness among Himalayan trekkers: the prevention of high altitude illness trial (PHAIT). BMJ. 2004; 328: 797
Basnyat B Gertsch JH Johnson EW, et al. Efficacy of low‐dose acetazolamide (125 mg BID) for the prophylaxis of acute mountain sickness: a prospective, double‐blind, randomized, placebo‐controlled trial. High Alt Med Biol 2003; 4:45–52.
Basnyat, B., Holck, P.S., Pun, M., Halverson, S., Szawarski, P., Gertsch, J. et al. Spironolactone does not prevent acute mountain sickness: a prospective, double-blind, randomized, placebo-controlled trial by SPACE Trial Group (spironolactone and acetazolamide trial in the prevention of acute mountain sickness group). Wilderness Environ Med. 2011; 30: 3-18.
Johnson T.S., Rock P.B., Fulco C.S. Prevention of acute mountain sickness by dexamethasone. N Engl J Med 1984; 310: 683–686.
Ellsworth, A.J., Larson, E.B., and Strickland, D. A randomized trial of dexamethasone and acetazolamide for acute mountain sickness prophylaxis. Am J Med. 1987; 83: 1024–1030
Ellsworth, A.J., Meyer, E.F., and Larson, E.B. Acetazolamide or dexamethasone use versus placebo to prevent acute mountain sickness on Mount Rainier. West J Med. 1991; 154: 289–293.
Maggiorini M., Brunner-La Rocca, H.P., Peth, S., Fischler, M., Bohm, T., Bernheim, A. et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Ann Intern Med. 2006; 145: 497–506
Bärtsch P., Swenson E.R., Acute High-Altitude Illnesses. N Engl J Med 2013; 368:2294-2302.
Imray C, Wright A, Subudhi A, Roach R. Acute mountain sickness: pathophysiology, prevention, and treatment. Prog. Cardiovasc. Dis. 2010; 52: 467–84.
Ferrazzini G., Maggiorini M., Kriemler, S., Bartsch, P., and Oelz, O. Successful treatment of acute mountain sickness with dexamethasone. Br Med J (Clin Res Ed). 1987; 294: 1380–1382
Hackett P.H., Roach, R.C., Wood, R.A., Foutch, R.G., Meehan, R.T., Rennie, D. et al. Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med. 1988; 59: 950–954
Levine, B.D., Yoshimura, K., Kobayashi, T., Fukushima, M., Shibamoto, T., and Ueda, G. Dexamethasone in the treatment of acute mountain sickness. N Engl J Med. 1989; 321: 1707–1713
Wright A, Brearey S, Imray C. High hopes at high altitudes: pharmacotherapy for acute mountain sickness and high‐altitude cerebral and pulmonary oedema. Expert Opinion on Pharmacotherapy 2008;9(1):119‐27.
Keller H.R. et al. Simulated descent v dexamethasone in treatment of acute mountain sickness: a randomised trial. Br Med J 1995; 310(6989): 1232-1235.
Pollard, A.J., Niermeyer, S., Barry, P., Bartsch, P., Berghold, F., Bishop, R.A. et al. Children at high altitude: an international consensus statement by an ad hoc committee of the International Society for Mountain Medicine, March 12, 2001. High Alt Med Biol. 2001; 2: 389–403
Grissom, C.K., Roach, R.C., Sarnquist, F.H., and Hackett, P.H. Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange. Ann Intern Med. 1992; 116: 461–465
Freeman K., Shalit M., and Stroh, G. Use of the Gamow bag by EMT-basic park rangers for treatment of high-altitude pulmonary edema and high-altitude cerebral edema. Wilderness Environ Med. 2004; 15: 198–201
Austin D. Gamow bag for acute mountain sick-ness. Lancet 1998; 351(9118):1815
Zafren K. Gamow bag for high-altitude cerebraloedema. Lancet 1998; 352(9124):325–326.
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