Interventions for treating acute high altitude illness.

Area of Science:

• Altitude Medicine and Physiology
• Clinical Pharmacology
• Evidence-Based Medicine

Background:

• Acute high altitude illness encompasses cerebral and pulmonary syndromes, commonly occurring above 2500 meters.
• Syndromes include acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE).
• Existing pharmacological and non-pharmacological treatments lack robust evidence regarding efficacy and safety.

Purpose of the Study:

• To evaluate the clinical effectiveness and safety of interventions for acute high altitude illness.
• To assess both pharmacological and non-pharmacological treatments, as monotherapy or combination therapy.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) published up to August 10, 2017.
• Searched multiple databases including CENTRAL, MEDLINE, Embase, and Web of Science.
• Included RCTs evaluating interventions for AMS, HACE, or HAPE in adults and adolescents.

Main Results:

• Thirteen RCTs with 468 participants were included; evidence quality was generally low.
• Dexamethasone showed potential for symptom relief in AMS (moderate quality evidence), while acetazolamide's effect was uncertain (low quality evidence).
• Non-pharmacological interventions like simulated descent showed minimal symptom reduction (low quality evidence); no serious adverse events reported for hyperbaric chambers or oxygen.

Conclusions:

• Limited evidence exists for interventions treating acute high altitude illness.
• Dexamethasone and acetazolamide may offer some benefit for AMS symptoms, but clinical significance and safety profiles remain uncertain.
• High-quality research is urgently needed due to the poor quality and reporting of existing trials.