One of our students recently came across a comprehensive publication on high altitude pulmonary edema (HAPE) on reputable point-of-care clinical resource UpToDate.com¹, citing Christine Ebert-Santos, MD, MPS, the founder of highaltitudehealth.com.

Emergency medicine physician at Aspen Valley Hospital and medical director for Mountain Rescue Aspen since 1997 Dr. Scott A. Gallagher² and emergency physician and altitude research pioneer Dr. Peter Hackett³ introduce the resource warning, “Anyone who travels to high altitude, whether a recreational hiker, skier, mountain climber, soldier, or worker, is at risk of developing high-altitude illness.”

Ebert-Santos’s (known affectionately to her patients and mountain community as “Dr. Chris”) own research is referenced in the article’s discussion of epidemiology and risk factors noting an additional category of HAPE among “children living at altitude who develop pulmonary edema with respiratory infection but without change in altitude,”⁴ whereas the two other recognized categories (classic HAPE and re-entry HAPE) typically happen in response to a change in altitude.

The article continues with figures illustrating how ascending too quickly or too much can dramatically increase risk: “HAPE generally occurs above 2500 meters (8000 feet) and is uncommon below 3000 meters (10,000 feet) … The risk depends upon individual susceptibility, altitude attained, rate of ascent, and time spent at high altitude. in those without a history of HAPE, the incidence is 0.2 percent with ascent to 4500 meters (14,800 feet) over four days but 6 percept when ascent occurs over one to two days. In those with a history of HAPE, recurrence is 60 percent with an ascent to 4500 meters over two days. At 5500 meters (18,000 feet), the incidence ranges between 2 and 15 percent, again depending upon rate of ascent.”

Dr. Chris discusses her experience treating her pediatric patients at high altitude in more depth in an interview with pediatric emergency medicine physician Dr. Alison Brent from Colorado Children’s Hospital for the podcast Charting Pediatrics.

Dr. Gallagher and Dr. Hackett’s article is available on UpToDate with a subscription.

References

1. https://www.uptodate.com/contents/high-altitude-pulmonary-edema?source=autocomplete&index=0~1&search=HAPE ↩︎
2. https://www.aspenhospital.org/people/scott-a-gallagher-md/ ↩︎
3. https://www.highaltitudedoctor.org/dr-peter-hackett ↩︎
4. Ebert-Santos, C. High-Altitude Pulmonary Edema in Mountain Community Residents. High Alt Med Biol 2017; 18:278. ↩︎