Prevention of High-Altitude Pulmonary Edema by Nifedipine

Bärtsch, Peter; Maggiorine, M.; Ritter, Manfred; Noti, C; Vock, Peter; Oelz, O

doi:10.1097/00132586-199206000-00060

Survey of Anesthesiology

1992

DOI: 10.1097/00132586-199206000-00060

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Prevention of High-Altitude Pulmonary Edema by Nifedipine

Peter Bärtsch

M. Maggiorine

Manfred Ritter

et al.

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Nifedipine does not prevent acute mountain sickness.

Hohenhaus¹,

Niroomand²,

Goerre³

et al. 1994

Am J Respir Crit Care Med

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Nifedipine has been shown effective for prevention and treatment of high altitude pulmonary edema (HAPE). Because acute mountain sickness (AMS) and HAPE may share common pathophysiologic mechanisms, we evaluate the prophylactic effect of nifedipine on the development of AMS in 27 mountaineers not susceptible to HAPE. They were randomly assigned to receive in a double-blind manner either nifedipine or placebo during rapid ascent to 4559 m and a subsequent three-day sojourn at this altitude. Nine of 14 subjects on nifedipine and eight of 13 subjects on placebo felt ill at high altitude. Pulmonary artery pressures (PAP) estimated by Doppler echocardiography were significantly lower with nifedipine, but arterial PO2, oxygen saturation, and alveolar-arterial oxygen pressure gradient were not significantly different between groups at high altitude. This study demonstrates that lowering PAP has no beneficial effect on gas exchange and symptoms of AMS in subjects not susceptible to HAPE. Therefore, nifedipine cannot be recommended for prevention of AMS, and its use in high altitude medicine should be limited to prevention and treatment of HAPE.

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Nifedipine does not prevent acute mountain sickness.

Hohenhaus¹,

Niroomand²,

Goerre³

et al. 1994

Am J Respir Crit Care Med

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Nocturnal periodic breathing and the development of acute high altitude illness.

Eichenberger

Weiss²,

Riemann³

et al. 1996

Am J Respir Crit Care Med

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We tested the hypothesis that periodic breathing (PB) at high altitude is more frequent and arterial oxygen desaturation more severe during sleep in subjects developing high altitude pulmonary edema (HAPE) or acute mountain sickness (AMS) compared with subjects remaining healthy. We registered thoraco-abdominal movement, electro-encephalogram and oxygen saturation by pulse oximeter (pSao2) in 21 subjects during the first night spent at the altitude of 4,559 m. During the subsequent stay at 4,559 m, eight subjects remained well (controls), five subjects developed AMS and eight subjects developed HAPE. PB was found in all sleep stages and the percentage PB in any sleep stage was not significantly different between groups. There was a trend towards more PB in the HAPE vs. AMS and control group lasting 80 +/- 5 (mean +/- SE), 58 +/- 7, 57 +/- 9% of analyzable time, respectively (p = 0.09). The mean nocturnal decrease of pSao2 for these groups was 8.7 +/- 1.9, 5.4 +/- 2.1, 4.8 +/- 1.2%; (p = 0.36) and the median nocturnal pSao2 was 49 +/- 3, 63 +/- 3, and 63 +/- 4% (p = 0.02). Arterial blood gas analysis before and after sleep recordings indicate that the significantly lower Sao2 in the HAPE group is secondary to gas exchange rather than ventilation. The nocturnal decrease of pSao2 did not correlate with the time of PB nor the number of desaturation events > or = 4%. These findings suggest that more frequent PB in the HAPE group is a consequence of lower Sao2 due to impairment of gas exchange.

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Prevention of High-Altitude Pulmonary Edema by Nifedipine

Cited by 2 publications

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Nifedipine does not prevent acute mountain sickness.

Nifedipine does not prevent acute mountain sickness.

Nocturnal periodic breathing and the development of acute high altitude illness.

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