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High Altitude Pulmonary Oedema
  1. DP Hall, Academic Foundation Doctor1,
  2. K Duncan, Consultant Anaesthetist2 and
  3. J Kenneth Baillie, Clinical Lecturer in Critical Care Medicine3
  1. 1Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Machermo, Nepal
  3. 3Division of Genetics and Genomics, The Roslin Institute, University of Edinburgh, UK Roslin EH25 9PS 0131 527 4455 0131 440 0434 j.k.baillie{at}ed.ac.uk

Abstract

High altitude pulmonary oedema (HAPE) is an important and preventable cause of death at high altitudes. However, little is known about the global incidence of HAPE, in part because most cases occur in remote environments where no records are kept. Furthermore, despite international efforts to achieve consensus, there is wide disparity in the diagnostic criteria in clinical and research use. We have reviewed the literature on the incidence and epidemiology of HAPE.

There is broad agreement between studies that HAPE incidence at 2500m is around 0.01%, and increases to 1.9% at 3600m and 2.5-5% at 4300m. Risk factors for HAPE include rate of ascent, intensity of exercise and absolute altitude attained, although an individual pre-disposition to developing the condition is also well described and suggests an underlying genetic susceptibility. It is increasingly recognised that clinically-detectable HAPE is an extreme of a continuous spectrum of excess pulmonary fluid accumulation, which has been demonstrated in asymptomatic individuals.

There is a continued need to ensure awareness of the diagnosis and treatment of HAPE among visitors to high altitude. It is likely that HAPE is preventable in all cases by progressive acclimatisation, and we advocate a pragmatic “golden rules” approach. Our understanding of the epidemiology and underlying genetic susceptibility to HAPE may be advanced if susceptible individuals register with the International HAPE Database: http://www.altitude.org/hape.php.

HAPE has direct relevance to military training and operations and is likely to be the leading cause of death at high altitude.

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