Physiological risk factors for severe high-altitude illness: a prospective cohort study.

Abstract:

RATIONALE:An increasing number of persons, exposed to high altitude for leisure, sport, or work, may suffer from severe high-altitude illness. OBJECTIVES:To assess, in a large cohort of subjects, the association between physiological parameters and the risk of altitude illness and their discrimination ability in a risk prediction model. METHODS:A total of 1,326 persons went through a hypoxic exercise test before a sojourn above 4,000 m. They were then monitored up at high altitude and classified as suffering from severe high-altitude illness (SHAI) or not. Analysis was stratified according to acetazolamide use. MEASUREMENTS AND MAIN RESULTS:Severe acute mountain sickness occurred in 314 (23.7%), high-altitude pulmonary edema in 22 (1.7%), and high-altitude cerebral edema in 13 (0.98%) patients. Among nonacetazolamide users (n = 917), main factors independently associated with SHAI were previous history of SHAI (adjusted odds ratios [aOR], 12.82; 95% confidence interval [CI], 6.95-23.66; P < 0.001), ascent greater than 400 m/day (aOR, 5.89; 95% CI, 3.78-9.16; P < 0.001), history of migraine (aOR, 2.28; 95% CI, 1.28-4.07; P = 0.005), ventilatory response to hypoxia at exercise less than 0.78 L/minute/kg (aOR, 6.68; 95% CI, 3.83-11.63; P < 0.001), and desaturation at exercise in hypoxia equal to or greater than 22% (aOR, 2.50; 95% CI, 1.52-4.11; P < 0.001). The last two parameters improved substantially the discrimination ability of the multivariate prediction model (C-statistic rose from 0.81 to 0.88; P < 0.001). Preventive use of acetazolamide reduced the relative risk of SHAI by 44%. CONCLUSIONS:In a large population of altitude visitors, chemosensitivity parameters (high desaturation and low ventilatory response to hypoxia at exercise) were independent predictors of severe high-altitude illness. They improved the discrimination ability of a risk prediction model.

authors

Richalet JP,Larmignat P,Poitrine E,Letournel M,Canouï-Poitrine F

doi

10.1164/rccm.201108-1396OC

subject

Has Abstract

pub_date

2012-01-15 00:00:00

pages

192-8

issue

2

eissn

1073-449X

issn

1535-4970

pii

201108-1396OC

journal_volume

185

pub_type

杂志文章
  • Randomized trial of adjunctive interleukin-2 in adults with pulmonary tuberculosis.

    abstract::Interleukin (IL)-2 has a central role in regulating T cell responses to Mycobacterium tuberculosis. Adjunctive immunotherapy with recombinant human IL-2 was studied in a randomized, placebo-controlled, double-blinded trial in 110 human immunodeficiency virus-seronegative adults in whom smear-positive, drug-susceptible...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1164/rccm.200211-1359OC

    authors: Johnson JL,Ssekasanvu E,Okwera A,Mayanja H,Hirsch CS,Nakibali JG,Jankus DD,Eisenach KD,Boom WH,Ellner JJ,Mugerwa RD,Uganda-Case Western Reserve University Research Collaboration.

    更新日期:2003-07-15 00:00:00

  • Differential gene expression in gram-negative and gram-positive sepsis.

    abstract::Sepsis is the most common cause of death in patients in the intensive care unit. Genome-wide gene expression analysis can provide insights into the molecular alterations of sepsis. Total mRNA was extracted from the livers of 6 uninfected control mice and 60 septic mice after infusion of either live Escherichia coli or...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/rccm.200211-1278OC

    authors: Yu SL,Chen HW,Yang PC,Peck K,Tsai MH,Chen JJ,Lin FY

    更新日期:2004-05-15 00:00:00

  • Production of nitric oxide (NO) in intrathoracic airways of normal humans.

    abstract::To gain insight into the source of exhaled nitric oxide (NO) in normal humans, we examined the effects of respiratory pattern on the concentration of NO in exhaled air while subjects were wearing a noseclip and then under endotracheal intubation, using a specially designed gas sampling system to separate exhaled air i...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.154.5.8912750

    authors: Tsujino I,Miyamoto K,Nishimura M,Shinano H,Makita H,Saito S,Nakano T,Kawakami Y

    更新日期:1996-11-01 00:00:00

  • Patent foramen ovale is not associated with hypoxemia in severe chronic obstructive pulmonary disease and does not impair exercise performance.

    abstract:RATIONALE:Patent foramen ovale (PFO) may be disadvantageous in chronic obstructive pulmonary disease (COPD). It is unknown whether right-to-left shunting through PFO increases during exercise impairing exercise performance. OBJECTIVES:To determine whether (1) PFO prevalence is greater in hypoxemic versus less hypoxemi...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/rccm.201309-1618OC

    authors: Shaikh ZF,Kelly JL,Shrikrishna D,de Villa M,Mullen MJ,Hopkinson NS,Morrell MJ,Polkey MI

    更新日期:2014-03-01 00:00:00

  • Lavage administration of dilute surfactants after acute lung injury in neonatal piglets.

    abstract::Exogenous surfactant therapy is not standard in the acute respiratory distress syndrome (ARDS) because of a lack of proven benefit. Nonuniform surfactant distribution after either bolus or aerosol administration may be an important factor limiting response. In a previous study of acute lung injury, we demonstrated tha...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.158.1.9704119

    authors: Balaraman V,Meister J,Ku TL,Sood SL,Tam E,Killeen J,Uyehara CF,Egan E,Easa D

    更新日期:1998-07-01 00:00:00

  • Mite and cat allergen levels in homes and severity of asthma.

    abstract::The relationships between mite and cat allergen levels in the home, skin test reactivity, and severity of asthma were explored in 120 asthmatic subjects, 57 in Vancouver and 63 in Winnipeg. Patients in the two cities were similar in age, gender distribution, and severity of asthma. Skin tests were performed using 13 c...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.152.6.8520740

    authors: Chan-Yeung M,Manfreda J,Dimich-Ward H,Lam J,Ferguson A,Warren P,Simons E,Broder I,Chapman M,Platts-Mills T

    更新日期:1995-12-01 00:00:00

  • Increased airways responsiveness in mice depends on local challenge with antigen.

    abstract::In Balb/C mice, painting the skin with ovalbumin (OVA) over a period of 14 days resulted in sensitization of the animals. This was documented by the appearance of OVA-specific IgE and IgG1 antibodies and increased total serum IgE levels. In addition, in regional (inguinal) lymph nodes of sensitized animals, OVA-specif...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.149.1.8111600

    authors: Saloga J,Renz H,Larsen GL,Gelfand EW

    更新日期:1994-01-01 00:00:00

  • Quantitative upper airway imaging with anatomic optical coherence tomography.

    abstract:BACKGROUND:Measurements of upper airway size and shape are important in investigating the pathophysiology of obstructive sleep apnea (OSA) and in devising, applying, and determining the effectiveness of treatment modalities. We describe an endoscopic optical technique (anatomic optical coherence tomography, aOCT) that ...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/rccm.200507-1148OC

    authors: Armstrong JJ,Leigh MS,Sampson DD,Walsh JH,Hillman DR,Eastwood PR

    更新日期:2006-01-15 00:00:00

  • Polymorphism within the interferon-gamma/receptor complex is associated with pulmonary tuberculosis.

    abstract:RATIONALE:Interferon-gamma (IFN-gamma) is of central interest in the study of tuberculosis. A number of single-gene mutations have been identified in the IFN-gamma signaling pathway that predispose to severe mycobacterial disease, but the relevance of polymorphism within these genes to the common phenotype of tuberculo...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/rccm.200601-088OC

    authors: Cooke GS,Campbell SJ,Sillah J,Gustafson P,Bah B,Sirugo G,Bennett S,McAdam KP,Sow O,Lienhardt C,Hill AV

    更新日期:2006-08-01 00:00:00

  • Inhaled colistin in patients with bronchiectasis and chronic Pseudomonas aeruginosa infection.

    abstract:RATIONALE:Chronic infection with Pseudomonas aeruginosa is associated with an increased exacerbation frequency, a more rapid decline in lung function, and increased mortality in patients with bronchiectasis. OBJECTIVES:To perform a randomized placebo-controlled study assessing the efficacy and safety of inhaled colist...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1164/rccm.201312-2208OC

    authors: Haworth CS,Foweraker JE,Wilkinson P,Kenyon RF,Bilton D

    更新日期:2014-04-15 00:00:00

  • The failure of STAT6-deficient mice to develop airway eosinophilia and airway hyperresponsiveness is overcome by interleukin-5.

    abstract::While signal transducer and activator of transcription protein 6 (STAT6) is important in interleukin-4 (IL-4)-induced commitment of CD4(+) T cells to the T helper cell, type 2 (Th2) phenotype and IgE isotype switching in B cells, its role in other IL-4-mediated events and their impact upon the allergic response is les...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.160.4.9809065

    authors: Tomkinson A,Kanehiro A,Rabinovitch N,Joetham A,Cieslewicz G,Gelfand EW

    更新日期:1999-10-01 00:00:00

  • Effects of cigarette smoke in mice with different levels of alpha(1)-proteinase inhibitor and sensitivity to oxidants.

    abstract::The role of strain difference in the response to cigarette smoke was investigated in mice. Mice of the strains DBA/2 and C57BL/6J responded to acute cigarette smoke with a decrease of the antioxidant defenses of their bronchoalveolar lavage (BAL) fluids. On the other hand, under these conditions ICR mice increased the...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.164.5.2010032

    authors: Cavarra E,Bartalesi B,Lucattelli M,Fineschi S,Lunghi B,Gambelli F,Ortiz LA,Martorana PA,Lungarella G

    更新日期:2001-09-01 00:00:00

  • Tuberculosis treatment outcomes: directly observed therapy compared with self-administered therapy.

    abstract::Effective treatment of tuberculosis requires adherence to a minimum of 6 months treatment with multiple drugs. To improve adherence and cure rates, directly observed therapy is recommended for the treatment of pulmonary tuberculosis. We compared treatment outcomes among all culture-positive patients treated for active...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/rccm.200401-095OC

    authors: Jasmer RM,Seaman CB,Gonzalez LC,Kawamura LM,Osmond DH,Daley CL

    更新日期:2004-09-01 00:00:00

  • Smooth reference equations for slow vital capacity and flow-volume curve indexes.

    abstract::We derived reference values for slow vital capacity (VC) and flow-volume curve indexes (FVC, FEV(1), and flows) from the 1,185 tracings provided by 1,039 "normal" subjects who participated in one or both cross-sectional surveys of the Po River Delta study in 1980-1982 and in 1988-1991. Definition of "normal" was based...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.161.3.9906006

    authors: Pistelli F,Bottai M,Viegi G,Di Pede F,Carrozzi L,Baldacci S,Pedreschi M,Giuntini C

    更新日期:2000-03-01 00:00:00

  • Cyclophosphamide prevents systemic keratinocyte growth factor-induced up-regulation of surfactant protein A after allogeneic transplant in mice.

    abstract::We reported that systemic keratinocyte growth factor (KGF) given before bone marrow transplantation (BMT) prevents allogeneic T cell-dependent lung inflammation assessed on Day 7 post-BMT, but the antiinflammatory effects of KGF were impaired in mice injected with both T cells and conditioning regimen of cyclophospham...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.162.5.2002053

    authors: Yang S,Panoskaltsis-Mortari A,Ingbar DH,Matalon S,Zhu S,Resnik ER,Farrell CL,Lacey DL,Blazar BR,Haddad IY

    更新日期:2000-11-01 00:00:00

  • The epidemiology of severe sepsis in children in the United States.

    abstract::Despite extensive research into the etiology and treatment of severe sepsis, little is known about its epidemiology in children. We sought to determine the age- and sex-adjusted incidence, outcome, and associated hospital costs of severe sepsis in United States children using 1995 hospital discharge and population dat...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/rccm.200207-682OC

    authors: Watson RS,Carcillo JA,Linde-Zwirble WT,Clermont G,Lidicker J,Angus DC

    更新日期:2003-03-01 00:00:00

  • Tracheal microvascular responses to beta-adrenergic stimulation in anesthetized rats.

    abstract::Previous study of adrenergic control of the tracheal vasculature in rats (1) demonstrated that beta-adrenergic blockade heightened arteriolar and large venular contractile responses to norepinephrine, a nonselective alpha-adrenergic agonist. The present study was undertaken to confirm the presence of functional beta-a...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.153.3.8630550

    authors: Corboz MR,Ballard ST,Inglis SK,Taylor AE

    更新日期:1996-03-01 00:00:00

  • Twelve months of isoniazid compared with four months of isoniazid and rifampin for persons with radiographic evidence of previous tuberculosis: an outcome and cost-effectiveness analysis.

    abstract::Isoniazid taken daily for 12 mo and isoniazid and rifampin taken daily for 4 mo are both recommended options for patients with radiographic evidence of previous tuberculosis and positive tuberculin skin tests who have not had prior treatment. We compared the completion rates, number of adverse effects, and cost effect...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.162.5.2003028

    authors: Jasmer RM,Snyder DC,Chin DP,Hopewell PC,Cuthbert SS,Antonio Paz E,Daley CL

    更新日期:2000-11-01 00:00:00

  • Derivation and validation of a prognostic model for pulmonary embolism.

    abstract:RATIONALE:An objective and simple prognostic model for patients with pulmonary embolism could be helpful in guiding initial intensity of treatment. OBJECTIVES:To develop a clinical prediction rule that accurately classifies patients with pulmonary embolism into categories of increasing risk of mortality and other adve...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/rccm.200506-862OC

    authors: Aujesky D,Obrosky DS,Stone RA,Auble TE,Perrier A,Cornuz J,Roy PM,Fine MJ

    更新日期:2005-10-15 00:00:00

  • Chronic intermittent hypoxia alters density of aminergic terminals and receptors in the hypoglossal motor nucleus.

    abstract:RATIONALE:Patients with obstructive sleep apnea (OSA) adapt to the anatomical vulnerability of their upper airway by generating increased activity in upper airway-dilating muscles during wakefulness. Norepinephrine (NE) and serotonin (5-HT) mediate, through α₁-adrenergic and 5-HT₂A receptors, a wake-related excitatory ...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/rccm.200912-1884OC

    authors: Rukhadze I,Fenik VB,Benincasa KE,Price A,Kubin L

    更新日期:2010-11-15 00:00:00

  • Muscle size and cardiorespiratory response to exercise in cystic fibrosis.

    abstract::The mechanism responsible for diminished exercise performance in cystic fibrosis (CF) is not clear. We hypothesized that reduced muscle size, rather than an intrinsic muscle defect, was the primary factor in such diminished exercise performance. Twenty-two subjects with CF (14 females and eight males, aged 6.5 to 17.7...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.162.5.2003057

    authors: Moser C,Tirakitsoontorn P,Nussbaum E,Newcomb R,Cooper DM

    更新日期:2000-11-01 00:00:00

  • A case of pulmonary AV fistula. Possible involvement of adenosine in hyperventilation.

    abstract::A 21-yr-old man with multiple pulmonary AV fistulae presented with moderate hypoxemia with chronic hyperventilation, which continued even after sufficient oxygenation by 100% O2 inhalation. The infusion of aminophylline, an adenosine receptor blocker, not only increased PaCO2 from 35 to 39 mm Hg but also depressed the...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1164/ajrccm.150.6.7952640

    authors: Kobayashi S,Nishimura M,Nasuhara Y,Miyamoto K,Kawakami Y

    更新日期:1994-12-01 00:00:00

  • Development and testing of formal protocols for oxygen prescribing.

    abstract::The absence of standardized assessment protocols with well- defined measurement properties limits comparison of outcomes among those receiving long-term oxygen therapy (LTOT). We describe simple protocols for a hospital test, a simulated home test, and an actual home test, their reliability and relationship to each ot...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 临床试验,杂志文章

    doi:10.1164/ajrccm.163.4.2002135

    authors: Guyatt GH,McKim DA,Weaver B,Austin PA,Bryan RE,Walter SD,Nonoyama ML,Ferreira IM,Goldstein RS

    更新日期:2001-03-01 00:00:00

  • Interleukin-8 messenger ribonucleic acid expression correlates with tumor progression, tumor angiogenesis, patient survival, and timing of relapse in non-small-cell lung cancer.

    abstract::Tumor-associated angiogenesis is important for tumor growth and metastasis. Interleukin (IL)-8 was recently reported to be an important angiogenic factor both in vitro and in vivo. In this study we evaluated, for the first time, IL-8 messenger RNA (mRNA) expression in non-small-cell lung cancer (NSCLC), using real-tim...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.162.5.2002108

    authors: Yuan A,Yang PC,Yu CJ,Chen WJ,Lin FY,Kuo SH,Luh KT

    更新日期:2000-11-01 00:00:00

  • Long-term influence of inhaled corticosteroids on bone metabolism and density. Are biological markers predictors of bone loss?

    abstract::Long-term effects of high doses of inhaled corticosteroids (ICS) on bone density and metabolism are still uncertain. Fifty-one patients (37 male, 14 female) using beclomethasone or budesonide at a daily dose > 800 microgram/d (high-dose group [Group HD] mean: 983 microgram/d [prescribed dose x estimated compliance]) o...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.159.3.9802096

    authors: Boulet LP,Milot J,Gagnon L,Poubelle PE,Brown J

    更新日期:1999-03-01 00:00:00

  • Nitric oxide modulates interleukin-1beta and tumor necrosis factor-alpha synthesis by alveolar macrophages in pulmonary tuberculosis.

    abstract::Interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha released from alveolar macrophages (AM) in pulmonary tuberculosis (TB) are important in host defense against mycobacterial infection. Nitric oxide (NO) production is enhanced in AM of TB patients. We examined whether NO was implicated in (IL)-1beta and TNF-a...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.161.1.9902113

    authors: Kuo HP,Wang CH,Huang KS,Lin HC,Yu CT,Liu CY,Lu LC

    更新日期:2000-01-01 00:00:00

  • Comparison between automatic and fixed positive airway pressure therapy in the home.

    abstract::We tested the hypothesis that continuous positive airway pressure (CPAP) use and outcomes can be improved by an autotitrating CPAP device in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) who require higher CPAP (10 cm H2O or more). In this multisite randomized single-blind cross-over study, 44 patien...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1164/rccm.200201-022OC

    authors: Massie CA,McArdle N,Hart RW,Schmidt-Nowara WW,Lankford A,Hudgel DW,Gordon N,Douglas NJ

    更新日期:2003-01-01 00:00:00

  • Influence of preservation solution on early graft failure in clinical lung transplantation.

    abstract::The aim of this study was to assess the influence of preservation solution type and extra- or intracellular composition on the occurrence of early graft dysfunction after clinical lung transplantation. For 170 patients who underwent a single (n = 124) or bilateral (n = 46) lung transplantation in two centers in Paris ...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章

    doi:10.1164/ajrccm.164.7.2012135

    authors: Thabut G,Vinatier I,Brugière O,Lesèche G,Loirat P,Bisson A,Marty J,Fournier M,Mal H

    更新日期:2001-10-01 00:00:00

  • Indications and Effects of Plasma Transfusions in Critically Ill Children.

    abstract:RATIONALE:Plasma transfusions are frequently prescribed for critically ill children, although their indications lack a strong evidence base. Plasma transfusions are largely driven by physician conceptions of need, and these are poorly documented in pediatric intensive care patients. OBJECTIVES:To identify patient char...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1164/rccm.201503-0450OC

    authors: Karam O,Demaret P,Shefler A,Leteurtre S,Spinella PC,Stanworth SJ,Tucci M,Canadian Critical Care Trials Group (CCCTG).,Pediatric Acute Lung Injury and Sepsis Investigators (PALISI).,BloodNet.,PlasmaTV Investigators.

    更新日期:2015-06-15 00:00:00

  • Physiologic Responsiveness Should Guide Entry into Randomized Controlled Trials.

    abstract::Most randomized trials in critical care report no mortality benefit; this may reflect competing pathogenic mechanisms, patient heterogeneity, or true ineffectiveness of interventions. We hypothesize that in acute respiratory distress syndrome (ARDS), randomizing only those patients who show a favorable physiological r...

    journal_title:American journal of respiratory and critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1164/rccm.201410-1832CP

    authors: Goligher EC,Kavanagh BP,Rubenfeld GD,Ferguson ND

    更新日期:2015-12-15 00:00:00