Interventions for preventing high altitude illness: Part 3. Miscellaneous and non-pharmacological interventions

Area of Science:

• Altitude Medicine
• Preventive Health Strategies
• Clinical Trial Analysis

Background:

• High altitude illness (HAI) encompasses cerebral and pulmonary syndromes occurring above 2500 meters.
• Acute mountain sickness (AMS), HACE, and HAPE are key concerns for high-altitude travelers.
• This review focuses on non-pharmacological and miscellaneous interventions for HAI prevention.

Purpose of the Study:

• To evaluate the clinical effectiveness of non-pharmacological interventions for preventing acute HAI.
• To assess adverse events associated with these preventive strategies.
• To provide evidence-based guidance for individuals at risk of high altitude illness.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) adhering to Cochrane methodology.
• Searched multiple databases including CENTRAL, MEDLINE, Embase, LILACS, and WHO ICTRP.
• Included RCTs using preacclimatization or non-pharmacological supplements administered before ascent.

Main Results:

• Preacclimatization methods (simulated altitude, RIPC) showed uncertain effects on AMS risk; PEEP showed potential benefit but with limited data.
• Supplements like antioxidants, medroxyprogesterone, and iron had uncertain effects; erythropoietin showed potential benefit but with low-quality evidence.
• Evidence for Ginkgo biloba was heterogeneous and conflicting, especially when compared to acetazolamide; safety data for most interventions were scarce.

Conclusions:

• Current evidence on non-pharmacological and miscellaneous interventions for HAI prevention is heterogeneous, contradictory, and limited.
• The safety of these interventions remains unclear due to a lack of comprehensive assessment.
• Further high-quality RCTs are needed, particularly those comparing interventions with pharmacological alternatives like acetazolamide.