Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update

Abstract

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention, diagnosis, and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches for managing each form of acute altitude illness that incorporate these recommendations as well as recommendations on how to approach high altitude travel following COVID-19 infection. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine in 2010 and the subsequently updated WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2014 and 2019.

Continuous Positive Airway Pressure in the Treatment of Pediatric High Altitude Pulmonary Edema: A Case Study

“…Descent in altitude remains the primary goal of any treatment plan regarding HAPE. 3 Oxygen is the most common initial medical intervention for HAPE when descent is unavailable or unsuccessful. However, not all patients with HAPE are responsive to oxygen therapy alone.…”

“…Additionally, only dexamethasone and acetazolamide are currently recommended in pediatrics. 3 Inhaled nitric oxide (iNO) has also been used as a treatment for severe HAPE in previous studies. 12 iNO serves to promote vasodilation of the pulmonary vasculature, thereby reducing the pulmonary hypertension (pHTN) often seen in these cases.…”

“…Interestingly, some medications have presented potential benefits in HAPE, including, but not limited to, nifedipine, tadalafil, and dexamethasone. 3,[7][8][9][10][11] Of note, none of the medications mentioned were available from either the clinic or the flight crew, and are not routinely caried by air medical crews in the region. Additionally, only dexamethasone and acetazolamide are currently recommended in pediatrics.…”