Thanks to a posting from EverestER, hospital I learned about a new set of guidelines on how to prevent and altitude related illnesses. High altitude is defined as above 2500m (8200 feet). I found it interesting reading and recommend it for anyone traveling to high altitude environments with the caveat that it is designed for health care professionals and should not be used as a substitute for a qualified physician.
The free paper is published by the Wilderness Medical Society (WMS). In the abstract the goal and approach of the study was
The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and ment of acute mountain sickness, high altitude cerebral edema and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians.
They established a set of grades ranging for 1A which is a “Strong recommendation, high-quality evidence” to 2C meaning “Weak recommendation, low-quality or very low quality evidence”.
Next they reviewed articles from the MEDLINE database using specific keywords such as acute mountain sickness, high altitude cerebral edema, prevention, acetazolamide, dexamethasone. They studied the data and reached their own consensus and thus a recommendation on a variety of illnesses and drugs.
At this point, I would strongly recommend reading the paper in it’s entirety (it is relatively short) but a few things caught my eye:
- A gradual ascent is highly effective in preventing AMS. The recommendation is that “individuals should not increase the sleeping elevation by more than 500 m per day and should include a rest day (ie, no ascent to higher sleeping elevation) every 3 to 4 days.”
- While Ginkgo biloba and coca leaves have gained popularity as a ‘natural’ way of acclimatizing, there are mixed results from various studies and thus received the lowest grade of 2C.
- Acetazolamide (Diamox) is widely accepted as the preferred method to potentially prevent AMS along with a gradual ascent. It received the highest grade of all drugs for AMS and HACE.
If you are planning an expedition perhaps taking a printed copy of the study to your Physician will help you and your Physician develop a good strategy. Thanks to the great people at EverestER for this pointer and to the WMS for an invaluable service.
Climb On!
Alan
