野外與登山醫學~~---35--WMS 2019 update HAPE TREATMENT Continuous positive airway pressure 35

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update
統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
HAPE 高海拔肺水腫
acute altitude illness 急性高海拔疾病

Continuous positive airway pressure As noted earlier, positive airway pressure works by increasing transmural pressure across alveolar walls, thereby increasing alveolar volume and improving ventilation-perfusion matching and, as a result, gas exchange. A small study demonstrated that EPAP, in which a mask system is used to increase airway pressure during exhalation only, improved gas exchange in patients with HAPE.99 However, although several reports document use of CPAP for management of HAPE in hospital and field settings,6,78 there is no systematic evidence that CPAP or EPAP improves patient outcomes compared to oxygen alone or in conjunction with medications. Given the low risks associated with the therapy, CPAP can be considered an adjunct to oxygen administration in a medical facility, provided the patient has normal mental status and can tolerate the mask. Although lithium batteryepowered devices and decreased size and weight of CPAP machines have increased feasibility of field use, logistical challenges remain and currently limit overall utility in this setting. Recommendation. CPAP or EPAP may be considered for treatment of HAPE when supplemental oxygen or pulmonary vasodilators are not available or as adjunctive therapy in patients not responding to supplemental oxygen alone. Recommendation Grade: 2C