Interpretation of the updated 2019 Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness_West China Medical Journal

Authors：

CHEN Lin ^1,2 , TANG Fajuan ^1,2 , XIAO Dongqiong ^1,2 ,  LI Xihong ^1,2

1. Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Xihong, Email: hilixihong@163.com

Keywords：

Acute altitude illness; Prevention; Treatment; Acetazolamide; Dexamethasone

DOI：

10.7507/1002-0179.202009215

Video：

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In 2019, the American Wilderness Medical Society updated and released a new version of the practice guidelines based on the practice guidelines for the prevention and treatment of acute altitude illness first published in 2010 and updated in 2014. This article interprets the guidelines, focusing on effective measures to prevent and treat different forms of acute altitude illness, as well as suggestions for specific methods to manage the disease, with a view to providing help for clinicians in better practice.

Citation： CHEN Lin, TANG Fajuan, XIAO Dongqiong, LI Xihong. Interpretation of the updated 2019 Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness. West China Medical Journal, 2020, 35(11): 1331-1337. doi: 10.7507/1002-0179.202009215 Copy

1.	Luks AM, Mcintosh SE, Grissom CK, et al. Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness. Wilderness Environ Med, 2010, 21(2): 146-155.
2.	Luks AM, McIntosh SE, Grissom CK, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med, 2014, 25(4 Suppl): S4-S14.
3.	Luks AM, Auerbach PS, Freer L, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update. Wilderness Environ Med, 2019, 30(4S): S3-S18.
4.	Honigman B, Theis MK, Koziol-Mclain J, et al. Acute mountain sickness in a general tourist population at moderate altitudes. Ann Intern Med, 1993, 118(8): 587-592.
5.	Gabry AL, Ledoux X, Mozziconacci M, et al. High-altitude pulmonary edema at moderate altitude (< 2, 400 m; 7, 870 feet): a series of 52 patients. Chest, 2003, 123(1): 49-53.
6.	Southard A, Niermeyer S, Yaron M. Language used in Lake Louise Scoring System underestimates symptoms of acute mountain sickness in 4- to 11-year-old children. High Alt Med Biol, 2007, 8(2): 124-130.
7.	Muhm JM, Rock PB, McMullin DL, et al. Effect of aircraft-cabin altitude on passenger discomfort. N Engl J Med, 2007, 357(1): 18-27.
8.	Hackett PH, Rennie D, Levine HD. The incidence, importance, and prophylaxis of acute mountain sickness. Lancet, 1976, 2(7996): 1149-1155.
9.	Beidleman BA, Muza SR, Fulco CS, et al. Intermittent altitude exposures reduce acute mountain sickness at 4300 m. Clin Sci (Lond), 2004, 106(3): 321-328.
10.	Wille M, Gatterer H, Mairer K, et al. Short-term intermittent hypoxia reduces the severity of acute mountain sickness. Scand J Med Sci Sports, 2012, 22(5): e79-e85.
11.	Fulco CS, Beidleman BA, Muza SR. Effectiveness of preacclimatization strategies for high-altitude exposure. Exerc Sport Sci Rev, 2013, 41(1): 55-63.
12.	Dehnert C, Böhm A, Grigoriev I, et al. Sleeping in moderate hypoxia at home for prevention of acute mountain sickness (AMS): a placebo-controlled, randomized double-blind study. Wilderness Environ Med, 2014, 25(3): 263-271.
13.	Basnyat B, Gertsch JH, Holck PS, et al. Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy (PACE) trial. High Alt Med Biol, 2006, 7(1): 17-27.
14.	Ellsworth AJ, Meyer EF, Larson EB. Acetazolamide or dexamethasone use versus placebo to prevent acute mountain sickness on Mount Rainier. West J Med, 1991, 154(3): 289-293.
15.	Leadbetter G, Keyes LE, Maakestad KM, et al. Ginkgo biloba does-and does not-prevent acute mountain sickness. Wilderness Environ Med, 2009, 20(1): 66-71.
16.	Lipman GS, Kanaan NC, Holck PS, et al. Ibuprofen prevents altitude illness: a randomized controlled trial for prevention of altitude illness with nonsteroidal anti-inflammatories. Ann Emerg Med, 2012, 59(6): 484-490.
17.	Lundeberg J, Feiner JR, Schober A, et al. Increased cytokines at high altitude: lack of effect of ibuprofen on acute mountain sickness, physiological variables, or cytokine levels. High Alt Med Biol, 2018, 19(3): 249-258.
18.	Gertsch JH, Lipman GS, Holck PS, et al. Prospective, double-blind, randomized, placebo-controlled comparison of acetazolamide versus ibuprofen for prophylaxis against high altitude headache: the Headache Evaluation at Altitude Trial (HEAT). Wilderness Environ Med, 2010, 21(3): 236-243.
19.	Bärtsch P, Merki B, Hofstetter D, et al. Treatment of acute mountain sickness by simulated descent: a randomised controlled trial. BMJ, 1993, 306(6885): 1098-1101.
20.	Keller HR, Maggiorini M, Bärtsch P, et al. Simulated descent v dexamethasone in treatment of acute mountain sickness: a randomised trial. BMJ, 1995, 310(6989): 1232-1235.
21.	Taber RL. Protocols for the use of portable hyperbaric chambers for the treatment of high altitude disorders. J Wild Med, 1990, 1: 181-192.
22.	Grissom CK, Roach RC, Sarnquist FH, et al. Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange. Ann Intern Med, 1992, 116(6): 461-465.
23.	Hackett PH, Roach RC, Wood RA, et al. Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med, 1988, 59(10): 950-954.
24.	Levine BD, Yoshimura K, Kobayashi T, et al. Dexamethasone in the treatment of acute mountain sickness. N Engl J Med, 1989, 321(25): 1707-1713.
25.	Harris NS, Wenzel RP, Thomas SH. High altitude headache: efficacy of acetaminophen vs. ibuprofen in a randomized, controlled trial. J Emerg Med, 2003, 24(4): 383-387.
26.	Bärtsch P, Maggiorini M, Mairbäurl H, et al. Pulmonary extravascular fluid accumulation in climbers. Lancet, 2002, 360(9332): 571; author reply 571-572.
27.	Baggish AL, Fulco CS, Muza S, et al. The impact of moderate-altitude staging on pulmonary arterial hemodynamics after ascent to high altitude. High Alt Med Biol, 2010, 11(2): 139-145.
28.	Bärtsch P, Maggiorini M, Ritter M, et al. Prevention of high-altitude pulmonary edema by nifedipine. N Engl J Med, 1991, 325(18): 1284-1289.
29.	Sartori C, Allemann Y, Duplain H, et al. Salmeterol for the prevention of high-altitude pulmonary edema. N Engl J Med, 2002, 346(21): 1631-1636.
30.	Maggiorini M, Brunner-La Rocca HP, Peth SA, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Ann Intern Med, 2006, 145(7): 497-506.
31.	Teppema LJ, Balanos GM, Steinback CD, et al. Effects of acetazolamide on ventilatory, cerebrovascular, and pulmonary vascular responses to hypoxia. Am J Respir Crit Care Med, 2007, 175(3): 277-281.
32.	Liptzin DR, Abman SH, Giesenhagen A, et al. An approach to children with pulmonary edema at high altitude. High Alt Med Biol, 2018, 19(1): 91-98.
33.	Yanamandra U, Nair V, Singh S, et al. Managing high-altitude pulmonary edema with oxygen alone: results of a randomized controlled trial. High Alt Med Biol, 2016, 17(4): 294-299.
34.	Freeman K, Shalit M, 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(3): 198-201.
35.	Schoene RB, Roach RC, Hackett PH, et al. High altitude pulmonary edema and exercise at 4, 400 meters on Mount McKinley. Effect of expiratory positive airway pressure. Chest, 1985, 87(3): 330-333.
36.	Oelz O, Maggiorini M, Ritter M, et al. Nifedipine for high altitude pulmonary oedema. Lancet, 1989, 2(8674): 1241-1244.
37.	Deshwal R, Iqbal M, Basnet S. Nifedipine for the treatment of high altitude pulmonary edema. Wilderness Environ Med, 2012, 23(1): 7-10.
38.	Fagenholz PJ, Gutman JA, Murray AF, et al. Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Alt Med Biol, 2007, 8(2): 139-146.
39.	Jones BE, Stokes S, McKenzie S, et al. Management of high altitude pulmonary edema in the Himalaya: a review of 56 cases presenting at Pheriche medical aid post (4240 m). Wilderness Environ Med, 2013, 24(1): 32-36.
40.	Singh I, Lal M, Khanna PK, et al. Augmentation of frusemide diuresis by morphine in high altitude pulmonary oedema. Br Heart J, 1967, 29(5): 709-713.

1. Luks AM, Mcintosh SE, Grissom CK, et al. Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness. Wilderness Environ Med, 2010, 21(2): 146-155.
2. Luks AM, McIntosh SE, Grissom CK, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med, 2014, 25(4 Suppl): S4-S14.
3. Luks AM, Auerbach PS, Freer L, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update. Wilderness Environ Med, 2019, 30(4S): S3-S18.
4. Honigman B, Theis MK, Koziol-Mclain J, et al. Acute mountain sickness in a general tourist population at moderate altitudes. Ann Intern Med, 1993, 118(8): 587-592.
5. Gabry AL, Ledoux X, Mozziconacci M, et al. High-altitude pulmonary edema at moderate altitude (< 2, 400 m; 7, 870 feet): a series of 52 patients. Chest, 2003, 123(1): 49-53.
6. Southard A, Niermeyer S, Yaron M. Language used in Lake Louise Scoring System underestimates symptoms of acute mountain sickness in 4- to 11-year-old children. High Alt Med Biol, 2007, 8(2): 124-130.
7. Muhm JM, Rock PB, McMullin DL, et al. Effect of aircraft-cabin altitude on passenger discomfort. N Engl J Med, 2007, 357(1): 18-27.
8. Hackett PH, Rennie D, Levine HD. The incidence, importance, and prophylaxis of acute mountain sickness. Lancet, 1976, 2(7996): 1149-1155.
9. Beidleman BA, Muza SR, Fulco CS, et al. Intermittent altitude exposures reduce acute mountain sickness at 4300 m. Clin Sci (Lond), 2004, 106(3): 321-328.
10. Wille M, Gatterer H, Mairer K, et al. Short-term intermittent hypoxia reduces the severity of acute mountain sickness. Scand J Med Sci Sports, 2012, 22(5): e79-e85.
11. Fulco CS, Beidleman BA, Muza SR. Effectiveness of preacclimatization strategies for high-altitude exposure. Exerc Sport Sci Rev, 2013, 41(1): 55-63.
12. Dehnert C, Böhm A, Grigoriev I, et al. Sleeping in moderate hypoxia at home for prevention of acute mountain sickness (AMS): a placebo-controlled, randomized double-blind study. Wilderness Environ Med, 2014, 25(3): 263-271.
13. Basnyat B, Gertsch JH, Holck PS, et al. Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy (PACE) trial. High Alt Med Biol, 2006, 7(1): 17-27.
14. Ellsworth AJ, Meyer EF, Larson EB. Acetazolamide or dexamethasone use versus placebo to prevent acute mountain sickness on Mount Rainier. West J Med, 1991, 154(3): 289-293.
15. Leadbetter G, Keyes LE, Maakestad KM, et al. Ginkgo biloba does-and does not-prevent acute mountain sickness. Wilderness Environ Med, 2009, 20(1): 66-71.
16. Lipman GS, Kanaan NC, Holck PS, et al. Ibuprofen prevents altitude illness: a randomized controlled trial for prevention of altitude illness with nonsteroidal anti-inflammatories. Ann Emerg Med, 2012, 59(6): 484-490.
17. Lundeberg J, Feiner JR, Schober A, et al. Increased cytokines at high altitude: lack of effect of ibuprofen on acute mountain sickness, physiological variables, or cytokine levels. High Alt Med Biol, 2018, 19(3): 249-258.
18. Gertsch JH, Lipman GS, Holck PS, et al. Prospective, double-blind, randomized, placebo-controlled comparison of acetazolamide versus ibuprofen for prophylaxis against high altitude headache: the Headache Evaluation at Altitude Trial (HEAT). Wilderness Environ Med, 2010, 21(3): 236-243.
19. Bärtsch P, Merki B, Hofstetter D, et al. Treatment of acute mountain sickness by simulated descent: a randomised controlled trial. BMJ, 1993, 306(6885): 1098-1101.
20. Keller HR, Maggiorini M, Bärtsch P, et al. Simulated descent v dexamethasone in treatment of acute mountain sickness: a randomised trial. BMJ, 1995, 310(6989): 1232-1235.
21. Taber RL. Protocols for the use of portable hyperbaric chambers for the treatment of high altitude disorders. J Wild Med, 1990, 1: 181-192.
22. Grissom CK, Roach RC, Sarnquist FH, et al. Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange. Ann Intern Med, 1992, 116(6): 461-465.
23. Hackett PH, Roach RC, Wood RA, et al. Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med, 1988, 59(10): 950-954.
24. Levine BD, Yoshimura K, Kobayashi T, et al. Dexamethasone in the treatment of acute mountain sickness. N Engl J Med, 1989, 321(25): 1707-1713.
25. Harris NS, Wenzel RP, Thomas SH. High altitude headache: efficacy of acetaminophen vs. ibuprofen in a randomized, controlled trial. J Emerg Med, 2003, 24(4): 383-387.
26. Bärtsch P, Maggiorini M, Mairbäurl H, et al. Pulmonary extravascular fluid accumulation in climbers. Lancet, 2002, 360(9332): 571; author reply 571-572.
27. Baggish AL, Fulco CS, Muza S, et al. The impact of moderate-altitude staging on pulmonary arterial hemodynamics after ascent to high altitude. High Alt Med Biol, 2010, 11(2): 139-145.
28. Bärtsch P, Maggiorini M, Ritter M, et al. Prevention of high-altitude pulmonary edema by nifedipine. N Engl J Med, 1991, 325(18): 1284-1289.
29. Sartori C, Allemann Y, Duplain H, et al. Salmeterol for the prevention of high-altitude pulmonary edema. N Engl J Med, 2002, 346(21): 1631-1636.
30. Maggiorini M, Brunner-La Rocca HP, Peth SA, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Ann Intern Med, 2006, 145(7): 497-506.
31. Teppema LJ, Balanos GM, Steinback CD, et al. Effects of acetazolamide on ventilatory, cerebrovascular, and pulmonary vascular responses to hypoxia. Am J Respir Crit Care Med, 2007, 175(3): 277-281.
32. Liptzin DR, Abman SH, Giesenhagen A, et al. An approach to children with pulmonary edema at high altitude. High Alt Med Biol, 2018, 19(1): 91-98.
33. Yanamandra U, Nair V, Singh S, et al. Managing high-altitude pulmonary edema with oxygen alone: results of a randomized controlled trial. High Alt Med Biol, 2016, 17(4): 294-299.
34. Freeman K, Shalit M, 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(3): 198-201.
35. Schoene RB, Roach RC, Hackett PH, et al. High altitude pulmonary edema and exercise at 4, 400 meters on Mount McKinley. Effect of expiratory positive airway pressure. Chest, 1985, 87(3): 330-333.
36. Oelz O, Maggiorini M, Ritter M, et al. Nifedipine for high altitude pulmonary oedema. Lancet, 1989, 2(8674): 1241-1244.
37. Deshwal R, Iqbal M, Basnet S. Nifedipine for the treatment of high altitude pulmonary edema. Wilderness Environ Med, 2012, 23(1): 7-10.
38. Fagenholz PJ, Gutman JA, Murray AF, et al. Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Alt Med Biol, 2007, 8(2): 139-146.
39. Jones BE, Stokes S, McKenzie S, et al. Management of high altitude pulmonary edema in the Himalaya: a review of 56 cases presenting at Pheriche medical aid post (4240 m). Wilderness Environ Med, 2013, 24(1): 32-36.
40. Singh I, Lal M, Khanna PK, et al. Augmentation of frusemide diuresis by morphine in high altitude pulmonary oedema. Br Heart J, 1967, 29(5): 709-713.

West China Medical Journal

Interpretation of the updated 2019 Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness

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