We undertook a computer-aided search of PubMed, and used the key words altitude, acute mountain sickness, high-altitude pulmonary edema, high-altitude pulmonary oedema, high-altitude cerebral edema, high-altitude cerebral oedema, hypoxia, and mountaineering. We also reviewed journal reference lists and abstracts from international scientific meetings, and used our existing knowledge of primary publications in the field. Priority was given to recent reports covering topical issues and
SeminarHigh-altitude illness
Section snippets
Epidemiology
The most important risk factors for the development of high-altitude illness are rate of ascent, altitude reached (especially the sleeping altitude), and individual susceptibility. The rate of AMS among conference delegates to moderate altitudes (1920–2957 m) in Colorado, USA, was 25%.2 In the Mount Everest region of Nepal, about 50% of trekkers who walk to altitudes higher than 4000 m over 5 or more days develop AMS,3, 4 and 84% of people who fly directly to 3860 m are affected.5 High-altitude
Clinical presentation
AMS is characterised by non-specific symptoms and a paucity of physical findings. The main symptoms are headache, anorexia, nausea, vomiting, fatigue, dizziness, and sleep disturbance, but not all need to be present. Headache is deemed the cardinal symptom, but the characteristics are not sufficiently distinctive to differentiate it from other causes of headache.20 Symptoms of AMS typically appear 6–12 h after arrival at high altitude. Diagnostic signs are absent, and the presence of abnormal
Clinical presentation
HAPE typically occurs in the first 2–4 days after arrival at altitudes higher than 2500 m, and is not necessarily preceded by AMS. Risk factors for HAPE are the same as for AMS and HACE. In addition, HAPE may be over-represented in men compared with women, and cold is a risk factor.85 People with abnormalities of the cardiopulmonary circulation that are associated with increased pulmonary blood-flow pressure, such as unilateral absence of a pulmonary artery or primary pulmonary hypertension, or
Search strategy and selection criteria
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