sábado, 28 de septiembre de 2013

Edema pulmonar/Pulmonary edema

Sueño y respiración en edema pulmonar de las alturas en sujetos susceptibles a 4559 metros  
Sleep and breathing in high altitude pulmonary edema susceptible subjects at 4,559 meters.
Nussbaumer-Ochsner Y, Schuepfer N, Ursprung J, Siebenmann C, Maggiorini M, Bloch KE.
Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, and Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
Sleep. 2012 Oct 1;35(10):1413-21.
STUDY OBJECTIVES: Susceptible subjects ascending rapidly to high altitude develop pulmonary edema (HAPE). We evaluated whether HAPE leads to sleep and breathing disturbances that are alleviated by dexamethasone. DESIGN: Double-blind, randomized, placebo-controlled trial with open-label extension. SETTING: One night in sleep laboratory at 490 m, 2 nights in mountain hut at 4,559 m. PARTICIPANTS: 21 HAPE susceptibles. INTERVENTION: Dexamethasone 2 × 8 mg/d, either 24 h prior to ascent and at 4,559 m (dex-early), or started on day 2 at 4,559 m only (dex-late). MEASUREMENTS:
Polysomnography, questionnaires on sleep and acute mountain sickness. RESULTS: Polysomnographies at 490 m were normal. In dex-late (n = 12) at 4,559 m, night 1 and 3, median oxygen saturation was 71% and 80%, apnea/hypopnea index 91.3/h and 9.6/h. In dex-early (n = 9), corresponding values were 78% and 79%, and 85.3/h and 52.3/h (P < 0.05 vs. 490 m, all instances). In dex-late, ascending from 490 m to 4,559 m (night 1), sleep efficiency decreased from 91% to 65%, slow wave sleep from 20% to 8% (P < 0.05, both instances). In dex-early, corresponding sleep efficiencies were 96% and 95%, slow wave sleep 18% and 9% (P < 0.05). From night 1 to 3, sleep efficiency remained unchanged in both groups while slow wave sleep increased to 20% in dex-late (P < 0.01). Compared to dex-early, initial AMS scores in dex-late were higher but improved during stay at altitude. CONCLUSIONS:HAPE susceptibles ascending rapidly to high altitude experience pronounced nocturnal hypoxemia, and reduced sleep efficiency and deep sleep. Dexamethasone taken before ascent prevents severe hypoxemia and sleep disturbances, while dexamethasone taken 24 h after arrival at 4,559 m increases oxygenation and deep sleep.
KEYWORDS: Control of breathing, dexamethasone, high altitude illness, hypoxia, sleep apnea 

Intubación endotraqueal y ventilación mecánica despues de falla respiratoria secundaria a edema pulmonar de las alturas      
Endotracheal intubation and mechanical ventilation following respiratory arrest from high altitude pulmonary edema.
Litch JA.
Himalayan Rescue Association, Kathmandu, Nepal. jlitch@yahoo.com
West J Med. 1999 Mar;170(3):174-6.
  Fisiología de las alturas en relación con la anestesia y la terapia inhalatoria             
Anesthesiology. 1964 Jul-Aug;25:515-31.

Dr. Francisco Martínez-Pelayo
Anestesiología y Medicina del Dolor
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