Liptzin Deborah R, Abman Steven H, Giesenhagen Ann, Ivy D Dunbar
1 Breathing Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado.
2 Heart Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado.
High Alt Med Biol. 2018 Mar;19(1):91-98. doi: 10.1089/ham.2017.0096. Epub 2018 Feb 22.
Liptzin, Deborah R., Steven H. Abman, Ann Giesenhagen, and D. Dunbar Ivy. An approach to children with pulmonary edema at high altitude. High Alt Med Biol. 19:91-98, 2018.
Diagnosis of high-altitude illness can be more challenging in children, especially those who are preverbal. Families often travel to high elevations for family vacations, either for skiing, hiking, and/or camping. They may present to their primary care providers looking for anticipatory guidance before travel or may follow-up after developing high-altitude illness. High-altitude pulmonary edema (HAPE) can be fatal.
There is no indication for HAPE prophylaxis in altitude naive children. Children may develop HAPE either when traveling from low altitude to high altitude for vacation (classic HAPE), when returning to high-altitude homes after travel to low altitude (reentry HAPE), or even with a respiratory illness at high altitude without any change in elevation (high-altitude resident pulmonary edema or HARPE). Children may be more susceptible to HAPE because of increased vascular reactivity, immature control of breathing, and increased frequency of respiratory illnesses. Children with HAPE warrant evaluation for underlying cardiopulmonary abnormalities, including structural heart disease and pulmonary hypertension. Treatment of HAPE includes supplemental oxygen and descent, but underlying cardiopulmonary disease may also help guide treatment and prevention.
Evaluation for structural heart disease and pulmonary hypertension should be considered in children with HAPE. Future studies should be done to elucidate the optimal strategies for prevention and treatment of HAPE and to better understand the development of HAPE in children.
黛博拉·R·利普津、史蒂文·H·阿布曼、安·吉森哈根和D·邓巴·艾维。一种治疗高原肺水肿患儿的方法。《高原医学与生物学》。2018年第19卷，第91 - 98页。
高原病在儿童中的诊断可能更具挑战性，尤其是那些尚不能言语的儿童。家庭经常前往高海拔地区度假，比如去滑雪、徒步旅行和/或露营。他们可能在旅行前向初级保健提供者寻求预防性指导，或者在患上高原病后进行随访。高原肺水肿（HAPE）可能是致命的。
对于未接触过高原的儿童，没有预防HAPE的指征。儿童可能在从低海拔前往高海拔度假时（典型的HAPE）、在前往低海拔地区旅行后返回高海拔家中时（再入性HAPE），甚至在高海拔地区患呼吸道疾病且海拔没有任何变化时（高原居民肺水肿或HARPE）患上HAPE。由于血管反应性增加、呼吸控制不成熟以及呼吸道疾病频率增加，儿童可能更容易患HAPE。患有HAPE的儿童需要评估是否存在潜在的心肺异常，包括结构性心脏病和肺动脉高压。HAPE的治疗包括补充氧气和下山，但潜在的心肺疾病也可能有助于指导治疗和预防。
对于患有HAPE的儿童，应考虑评估其是否存在结构性心脏病和肺动脉高压。未来应开展研究，以阐明预防和治疗HAPE的最佳策略，并更好地了解儿童HAPE的发病机制。
