Non-rebreathing masks

High-altitude pulmonary oedema: Newer treatment modalities for an age-old problem

Background & objectives

High-altitude pulmonary oedema (HAPE) continues to challenge the healthcare providers at remote, resource-constrained settings. High-altitude terrain itself precludes convenience of resources. This study was conducted to evaluate the rise in peripheral capillary saturation of oxygen (SpO₂) by the use of a partial rebreathing mask (PRM) in comparison to Hudson's mask among patients with HAPE.

Methods

This was a single-centre, randomized crossover study to determine the efficiency of PRM in comparison to Hudson's mask. A total of 88 patients with HAPE referred to a secondary healthcare facility at an altitude of 11,500 feet from January to October 2013 were studied. A crossover after adequate wash-out on both modalities was conducted for first two days of hospital admission. All patients with HAPE were managed with bed rest and stand-alone oxygen supplementation with no adjuvant pharmacotherapy.

Results

The mean SpO₂on ambient air on arrival was 66.92±10.8 per cent for all patients with HAPE. Higher SpO₂values were achieved with PRM in comparison to Hudson's mask on day one (86.08±5.15 vs. 77.23±9.09%) and day two (89.94±2.96 vs. 83.39±5.93%). The difference was more pronounced on day one as compared to day two.

Interpretation & conclusions

Mean SpO₂values were found to be significantly higher among HAPE patients using PRM compared to those on Hudson's mask. Further studies to understand the translation of this incremental response in SpO₂to clinical benefits (recovery times, mortality rates and hospital stay) need to be undertaken.