Edema pulmonar inducido por las alturas
High altitude pulmonary edema
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El edema pulmonar inducido por las alturas hace parte del grupo de enfermedades inducidas por la altitud. En la actualidad existen numerosas inquietudes en su fisiopatología, manifestaciones clínicas y tratamiento. En el presente artículo se revisa la literatura disponible hasta el momento de esta enfermedad, pretendiendo aclarar estos aspectos. Además, se hace referencia a los resultados de estudios realizados en Colombia, con el fin de orientar un manejo adecuado de estos pacientes en nuestro medio.
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- Moore LG, Niermeyer S, Zamudio S. Human adaptation to high altitude: regional and life-cycle perspectives. Am J Phys Anthropol 1998; Suppl 27: 25-64.
- West JB, The Physiologic Basis Of High-Altitude Diseases. Ann Intern Med, 2004; 141: 789-800.
- The Lake Louis Consensus on the Definition and Quantification of Altitude Illness. In: Sutton JR, Coates G, Houston C, editors. Hypoxia and mountain medicine. Burlington (VT): Queen City Press; 1992.
- Bärtsch P, Vock P, Maggiorini M, Franciolli M, et al. Respiratory symptoms, radiographic and physiologic correlations at high altitude. In: Sutton JR, Coates G, Remmers JE, eds. Hypoxia: the adaptations. Toronto: BC Decker; 1990: 241-5.
- Hurtado A. Aspectos Fisiológicos de la vida en la Altura. Lima: Empresa Edit. Rimac S.A.; 1937. (Resumen).
- Hultgren H, Spickard W. Medical experiences in Peru. Stanford Med Bull 1960; 18: 76-95.
- Houston C. Acute pulmonary edema of high altitude. N Engl J Med 1960; 263: 478-80.
- Hultgren H, Lopez CE, Lundberg E, Miller H. Physiologic studies of pulmonary edema at high altitude. Circulation 1964; 29: 393-408.
- Montgomery AB, Millis J, Luce JM. Incidence of acute mountain sickness at intermediate altitude. JAMA 1989; 261: 732-4.
- Hackett PH, Roach RC. High-altitude illness. N Engl J Med 2001; 345:107-14.
- Schneider M, Bernasch D, Weymann J, Holle R, Bartsch P. Acute mountain sickness: influence of susceptibility, preexposure, and ascent rate. Med Sci Sports Exerc 2002; 34: 1886-91.
- Hackett PH, Creagh CE, Grover RF, Honigman B, et al. High altitude pulmonary edema in persons without the right pulmonary artery. N Engl J Med 1980; 302: 1070-3.
- Mortimer H, Patel S, Peacock SJ. The genetic basis of high-altitude pulmonary oedema. Pharmacol Ther 2004, 101; 183-92.
- Sophocles AM. High-altitude pulmonary edema in Vail, Colorado, 1975–1982. West J Med 1986; 144: 569-73.
- Maggiorini M, Buhler B, Walter M, Oelz O. Prevalence of acute mountain sickness in the Swiss Alps. BMJ 1990; 301:853-5.
- Bartsch P. High altitude pulmonary edema. Med Sci Sports Exerc 1999; 31 (Suppl 1): S23-7.
- Singh I, Roy SB. High altitude pulmonary edema: clinical, hemodynamic, and pathologic studies. In: Command UARaD, editor. Biomedicine of high terrestrial elevation problems; 1969. p. 108–20. Washington D.C.
- Hackett PH, Rennie D. Rales, peripheral edema, retinal hemorrhage and acute mountain sickness. Am J Med 1979; 67: 214-8.
- 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: 587-92.
- Roach RC, Maes D, Sandoval D, et al. Exercise exacerbates acute mountain sickness at simulated high altitude. J Appl Physiol 2000; 88: 581-5.
- Hirata K, Masuyama S, Saito A. Obesity as risk factor for acute mountain sickness. Lancet 1989; 2 (8670): 1040-1.
- Maldonado D. High altitude pulmonary edema. Radiol Clin N Am 1978; 16: 537-49.
- Borda A, Bastidas A, Pernett F. Caracterización de pacientes con edema pulmonar inducido por las alturas en el Hospital Militar Central 1999-2006. Acta Medica de Cuidado Critico 2008.
- Rodway GW, Hoffman LA, Sanders MK. High-altitude-related disorders–Part I: Pathophysiology, differential diagnosis, and treatment, Heart Lung 2003; 32: 253-9.
- Purkayastha S, Ray B, Arora P, Chhabra P, et al. Aclimatization at high altitude in gradual and acute induction, J. Appl Physiol 1995; 79: 487-92.
- Savourey G, Launay J, Besnard Yves, Guinet A, Travers S. Normo and hipobaric hypoxia: are there any physiological difference? Eur J Appl Physiol 2003; 89: 122-6.
- Duplain H, Vollenweider L, Delabays A, et al. Augmented sympathetic activation during short-term hypoxia and high altitude exposure in subjects susceptible to high-altitude pulmonary edema. Circulation 1999; 99: 1713-8.
- Tom D, Hilde S, Rudy S, Caceres E, et al. Effect of developmental and ancestral high-altitude exposure on VO2 peak of Andean and European/North American Natives. Am J Physical Anthropol 1999; 110: 435-55.
- Hanaoka M, Kubo K, Yamazaki Y, Miyahara T, et al. Association of high-altitude pulmonary edema with the mayor histocompatibility complex. Circulation 1998; 97: 1124-8.
- Robert N, Daniel B, Vachiéry J, Vuyst P. High-altitude pulmonary edema with primary pulmonary hypertension. Chest 1996; 110: 286-9.
- Durmowicz A. Pulmonary edema in 6 children with Down syndrome during travel to moderate altitudes. Pediatrics 2001; 108: 443-7.
- Ge R, Matsuzawa Y, Takeoka M, Kubo K, et al. Low pulmonary diffusing capacity in subjects with acute mountain sickness. Chest, 111: 58-64, 1997.
- Weiskope R, Severinghaus J. Diffusing capacity of the lung for CO in man during acute acclimation to 14246 ft. J Appl Physiol 1972; 32: 285-9.
- Grûning E, Mereles D, Hildebrandt W, Swenson E. Stress Doppler echocardiography for identification of susceptibility to high altitude pulmonary edema. J Am Coll Cardiol 2000; 35: 980-7.
- Peacock A. High altitude pulmonary oedema: who gets it and why? Eur Respir J 1995; 8: 1819-21.
- Kenneth E, Lopez J, Buckler K, Archer S. Acute Oxygen Sensing Mechanisms, N Engl J Med 2005; 353: 2042-55.
- Aaronson PI, Roberson TP, Knock GA, et al. Hypoxic pulmonary vasoconstriction: mechanisms and controversies, J. Physiol 2006; 570: 53-8.
- Ge RL, Witkowsk S, Zhang Y, Alfrey C, et al. Determinants of erythropoietin release in response to short-term hypobaric hypoxia. J Appl Physiol 2002; 92: 2361-7.
- Zhu H, Jackson T, Bunn F. Detecting and responding to hypoxia. Nephrol Dial Transplant 2002; 17 (Suppl 1): 3-7.
- Boussat S, Eddahibi S, Coste A, Fataccioli V, et al. Expression and regulation of vascular endothelial growth factor in human pulmonary epithelial cells. Am J Physiol Lung Cell Mol Physiol 2000; 279: L371-8.
- Kourembanas S, Morita T, Christou H, Liu Y, et al. Hypoxic responses of vascular cells. Chest 1998; 114: 25-8.
- Hotta J, Hanaoka M, Droma Y, Katsuyama Y, et al. Polymorphisms of Renin-Angiotensin system genes with high altitude pulmonary edema in japanese subjects. Chest 2004; 126: 825-30.
- Hanaoka M, Droma Y, Hotta J, Matsuzawa Y, Kobayashi T, Kubo K, et al. Polymorphisms of the Tyrosine Hydroxylase Gene in Subjects Susceptible to Higt-Altitude Pulmonary Edema. Chest 2004; 126: 825-830.
- Saxena S, Kumar R, Madan T, Gupta V, et al. Association of polymorphisms in pulmonary surfactant protein A1 and A2 genes with high-altitude pulmonary edema. Chest 2005, 128:1611-9.
- Richalet J, High altitude pulmonary oedema: Still a place for controversy? Thorax 1995; 50: 923-9.
- Hong Z, Weir EK, Nelson DP, Olsehewski A. Subacute hypoxia decreases voltage-activated potassium channel expression and function in pulmonary artery myocytes. Am J Respir Cell Mol Biol 2004; 31: 337-43.
- Murray F, Insel PA, Yuan JX. Role of O2-sensitive K+ and Ca2+channels in the regulation of the pulmonary circulation: potential role of caveolae and implications for high altitude pulmonary edema. Respir Physiol Neurobiol 2006; 151: 192-208.
- Berger MM, Hesse C, Dehnert C, Siedler H, Kleinbongard P, et al. Hypoxia impairs systemic endothelial function in individuals prone to high-altitude pulmonary edema. Am J Respir Crit Care Med 2005; 172: 763-7.
- Grisson C, Zimmerman G, Whatley R, et al. Endothelial selectins in acute mountain sickness and high-altitude pulmonary edema. Chest 1997; 112: 1572-8.
- Bärtsch P, Lämmle B, Huber I, Haeberli A, et al. Contact phase of blood coagulation is not activated in edema of high altitude. J Appl Physiol 1989; 67: 1336-40.
- Stuehr D, Santolini J, Quing Z. Update on mechanism and catalytic regulation in the no synthases. J Biol Chem 2004; 279: 36137-70.
- Stuehr D, Pou S, Rosen GM. Oxygen reduction by nitric-oxide synthases. J Biol Chem 2001; 276: 14533-6.
- Mason N. The pathology of high altitude: an introduction to the disease states of high altitude. Curr Anaesth Crit Care 2000; 11: 104-12.
- Hankim TS, Michel RP, Minami H, Chang HK. Site of pulmonary hypoxic vasoconstriction studied with arterial and venous occlusion. J Appl Physiol 1983; 54: 1298-302.
- Maggiorini M, Mélot C, Pierre S, Pferiffer F. High-altitude pulmonary edema is initially caused by an increase in capillary pressure. Circulation 2001; 103: 2078-83.
- Cremona G, Asnaghi R, Baderna P, Brunetto A, Brustsaert T. Pulmonary extrvascular fluid accumulation in recreational climbers: a prospective study, Lancet 2002; 359: 303-9.
- West JB, Tsukimoto K, Mathieu-Costello O, Prediletto R. Stress failure in pulmonary capillaries. J Appl Physiol 1991; 70: 1731-42.
- Swenson ER, Maggiorini M, Mongovin S, Gibbs J. Pathogenesis of high-altitude pulmonary edema, inflammation is not an etiologic factor. JAMA 2002; 287: 2228-35.
- Clough AV, Haworth ST, Ma W, Dawson CA. Effects of hypoxia on pulmonary microvascular volume. Am J Physiol Heart Circ Physiol 2000; 279: H1274-82.
- Wagner WW, Latham LP, Capen RL. Capillary recruitment during airway hypoxia: role of pulmonary artery pressure. J Appl Physiol 1979; 47: 383-7.
- Hopkins SR, Garg J, Bolar DS, Balousch J, Levin DL. Pulmonary blood flow heterogeneity during hypoxia and high-altitude pulmonary edema. Am J Respir Crit Care Med 2005; 171: 83-7.
- Hopkins SR, Levin DL. Heterogeneous pulmonary blood flow in response to hypoxia: a risk factor for high altitude pulmonary edema? Respir Physiol Neurobiol 2006; 151: 217-28.
- Lamm WJ, Starr IR, Neradilek B, et al. Hypoxic pulmonary vasoconstriction is heterogeneously distributed in the prone dog. Respir Physiol Neurobiol 2004; 144: 281-94.
- Matthay M, Folkesson H, Clerici C, Lung epithelial fluid transport and the resolution of pulmonary edema. Physiol Rev 2002; 82:569-600.
- Oliver R, Scherrer U, Horisberger J, Rossier B, Hummler E. Lung edema clearance: 20 years of progress, selected contribution: limiting Na+ transport rate in airway epithelia from alpha-ENaC transgenic mice: a model for pulmonary edema, J Appl Physiol 2002; 93: 1881-7.
- Mairbäurl H. Role of alveolar epithelial sodium transport in high altitude pulmonary edema. Respir Physiol Neurobiol 2006; 151:178-91.
- Dada L, Chandel N, Ridge K, Pedemonte C, Berorello A, Sznajder J. Hypoxia-induced endocitosis of Na, K-ATPase in alveolar epithelial cells is mediated by mitochondrial reactive oxygen species and PKC-zeta. J Clin Invest 2003; 111: 1057-64.
- Bärtsch P, Shaw S, Franciolli M, Gnädinger MP, Widemann P. Atrial natriuretic peptide in acute mountain sickness. J Appl Physiol 1988; 65: 1929-37.
- Schoene RB. Illnesses at high altitude, Chest 2008; 134: 402-16.
- Schoene RB. Unraveling the mechanism of high altitude pulmonary edema. High Alt Med Biol. 2004; 5: 125-35.
- Gabry AL, Ledoux S, Mozziconacci M, Martin C. High-altitude pulmonary edema at moderate altitude (< 2400 m; 7,890 feet) a series of 52 patients. Chest 2003; 123: 49-53.
- Norboo T, Saiyed HN, Angchuk PT, Tsering P, et al. Mini review of high altitude health problems in Ladakh. Biomed Pharmacother 2004; 58: 220-5.
- Kobayashi T, Koyama S, Kubo KMF, Kusama S. Clinical features of patients with high altitude pulmonary edema in Japan. Chest 1987; 92: 814-21.
- Maggiorini M, Bärtsch P, Oelz O. Association between raised body temperature and acute mountain sickness: a cross sectional study. BMJ 1997; 315: 403-4.
- Hultgren HN. High altitude pulmonary edema: current concepts. Ann Rev Med 1996; 47: 267-84.
- Hultgren HN, Honigman B, Theis K, Nicholas D. High-altitude pulmonary edema at a ski resort. West J Med 1996; 164: 222-7.
- Vock P, Fretz C, Franciolli M, Bärtsch P. High altitude pulmonary edema: findings at high altitude chest radiography and physical examination. Radiology 1989; 170: 661-6.
- Hackett PH, Roach RC: High-Altitude Medicine. In: Auerbach PS (ed): Wilderness Medicine, 3rd edition; Mosby, St. Louis, MO 1995; 1-37.
- Swenson S, Maggiorini M, Mongovin S, Gibbs S, Greve I, Maierbaurl H, et al. High altitude pulmonary edema is a noninflammatory high permeability leak of the alveolar–capillary barrier. JAMA 2002; 287: 2226-35.
- King JS, Greenlee RR. Successful use of the Gamow hyperbaric bag in the treatment of altitude illness at Mount Everest. J Wilderness Med 1990; 1:193-202.
- Taber RL. Protocols for the use of portable hyperbaric chamber for the treatment of high altitude disorders. J Wilderness Med 1990;1: 181-92.
- Maggiorini M. High altitude-induced pulmonary oedema. Cardiovasc Res 2006; 72: 41-50.
- Larson EB. Positive airway pressure for high-altitude pulmonary oedema. Lancet 1985; 1: 371-3.
- Oelz O, Maggiorini M, Ritter M, Waber U, Jenni R, Vock P, et al. Nifedipine for high altitude pulmonary oedema. Lancet 1989; 2: 1241-4.
- Maggiorini M, Brunner HP, Peth S, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema. Ann Intern Med 2006; 145: 497-506.
- Hackett PH, Roach RC, Hartig GS, Greene ER, Levine BD. The effect of vasodilators on pulmonary hemodynamics in high altitude pulmonary edema: a comparison. Int J Sports Med 1992; 13 (Suppl 1): S68-S71.
- Zhao L, Mason N, Morrel N, Kojomazarov B, et al. Sildenafil inhibits hypoxia-induced pulmonary hypertension. Circulation 2001; 104: 424-8.
- Eldridge MW, Braun RK, Yoneda KY, Walby WF. Effects of altitude and exercise on pulmonary capillary integrity: evidence for subclinical high-altitude pulmonary edema. J Appl Physiol 2006; 100: 972-80.
- Maggiorini M, Brunner-La Rocca H-P, Bärtsch P, et al. Dexamethasone and tadalafil prophylaxis prevents both excessive pulmonary constriction and high altitude pulmonary edema in susceptible subjects. Eur Respir J 2004; 24 (Suppl 28) :S110.92. Bärtsch P, Maggiorini M, Ritter M, Noti C,Vock P, Oelz O. Prevention of high altitude pulmonary edema by nifedipine. NEngl J Med 1991; 325: 1284-9.
- Hohne C, Krebs MO, Seiferheld M, Boemke W, et al. Acetazolamide prevents hypoxic pulmonary vasoconstriction in conscious dogs. J Appl Physiol 2004; 97: 515-21.
- Murata T, Hori M, Sakamoto K, Karaki H,Ozaki H. Dexamethasone blocks hypoxia-induced endothelial dysfunction in organ-cultured pulmonary arteries. Am J Respir Crit Care Med 2004; 170: 647-55.
- Asoh K, Kumai T, Murano K, Kobayashi S, Koitabashi Y. Effect of antenatal dexamethasone treatment on Ca2+-dependent nitric oxide synthase activity in rat lung. Pediatr Res 2000; 48: 91-5.
- Stelzner TJ, O’Brien RF, Sato K,Weil JV. Hypoxia-induced increases in pulmonary transvascular protein escape in rats. Modulation by glucocorticoids. J Clin Invest 1988; 82: 1840-7.
- Stenmark KR, Davie NJ, Reeves JT, Frid MG. Hypoxia, leukocytes, and the pulmonary circulation. J Appl Physiol 2005; 98: 715-21.