Höhenmedizin

Höhenaufenthalte von Menschen sind viel häufiger als allgemein angenommen. Ab einer Höhe von 2500 m können Höhenerkrankungen auftreten, die mitunter lebensbedrohlich sind. Dieser Beitrag gibt einen Überblick über Risikofaktoren, präventive Aspekte und Therapieoptionen.

Abstract

High altitude activities are much more frequent than generally assumed. At altitudes of 2500 m and above, altitude-related illnesses can occur, which are sometimes life-threatening. This article gives an overview of risk factors, preventive aspects, and therapeutic options.

Kernaussagen

• Die beste Prävention für Höhenerkrankungen ist die Akklimatisation.

• Die kausale Therapie für Höhenerkrankungen ist der Abstieg.

• Die akute Bergkrankheit (Acute Mountain Sickness; AMS) ist meist vor Ort therapierbar und nicht lebensgefährlich.

• Das Höhenhirn- (High Altitude Cerebral Edema, HACE) und Höhenlungenödem (High Altitude Pulmonary Edema; HAPE) sind akut lebensbedrohlich und erfordern eine sofortige Höhenreduktion mit additiver medikamentöser Therapie.

• Nicht medikamentöse Therapieoptionen sind Abstieg/Abtransport, Sauerstoffgabe, Überdrucksack und positiver Atemwegsdruck.

• Medikamentöse Therapieoptionen sind für schwere oder sogar lebensgefährliche Erkrankungen Dexamethason (schwere AMS, HACE) und Nifedipin retard (HAPE).

Schlüsselwörter

Akute Bergkrankheit AMS - Akklimatisation - Höhenlungenödem HAPE - Höhenhirnödem HACE

Keywords

acute Mountain Sickness AMS - high Altitude cerebral Edema HACE - high Altitude pulmonary Edema HAPE - acclimatisation

Publication History

Article published online:
11 April 2023

• Literatur

• 1 Luks AM, Auerbach PS, Freer L. et al. Wilderness medical society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 Update. Wilderness Environ Med 2019; 30: S3-S18 DOI: 10.1016/j.wem.2019.04.006. (PMID: 31248818)
• 2 Burtscher M, Hefti U, Hefti JP. High-altitude illnesses: Old stories and new insights into the pathophysiology, treatment and prevention. Sports Med Health Sci 2021; 3: 59-69 DOI: 10.1016/j.smhs.2021.04.001. (PMID: 35782163)
• 3 Küpper T, Milledge JS, Hillebrandt D. et al. Work in hypoxic conditions--consensus statement of the Medical Commission of the Union Internationale des Associations d’Alpinisme (UIAA MedCom). Ann Occup Hyg 2011; 55: 369-386 DOI: 10.1093/annhyg/meq102.
• 4 Luks AM, Hackett PH. Medical conditions and high-altitude travel. N Engl J Med 2022; 386: 364-373 DOI: 10.1056/NEJMra2104829. (PMID: 35081281)
• 5 Roach RC, Lawley JS, Hackett PH. High-Altitude Physiology. In: Cushing TA, Harris NS, Auerbach PS. Auerbach’s Wilderness Medicine. Expert Consult. Philadelphia, PA: Elsevier; 2017: 2-8
• 6 Bärtsch P, Swenson ER. Clinical practice: Acute high-altitude illnesses. N Engl J Med 2013; 368: 2294-2302 DOI: 10.1056/NEJMcp1214870. (PMID: 23758234)
• 7 Küpper T, Gieseler U, Angelini C. et al. Consensus statement of the UIAA Medical Commission, vol 2. Emergency field management of acute mountain sickness, high altitude pulmonary edema, and high altitude cerebral edema [intended for doctors, interested non-medical persons and trekking or expedition operators] Update 2012. Accessed March 09, 2023 at: https://theuiaa.org/mountain-medicine/medical-advice/
• 8 Bärtsch P. The impact of nocebo and placebo effects on reported incidence of acute mountain sickness. High Alt Med Biol 2022; 23: 8-17 DOI: 10.1089/ham.2021.0078. (PMID: 34964659)
• 9 Lechner R, Küpper T, Tannheimer M. Challenges of military health service support in mountain warfare. Wilderness Environ Med 2018; 29: 266-274 DOI: 10.1016/j.wem.2018.01.006. (PMID: 29551528)
• 10 Roach RC, Hackett PH, Oelz O. et al. The 2018 Lake Louise Acute Mountain Sickness Score. High Alt Med Biol 2018; 19: 4-6 DOI: 10.1089/ham.2017.0164. (PMID: 29583031)
• 11 Gabry AL, Ledoux X, Mozziconacci M. et al. High-altitude pulmonary edema at moderate altitude (< 2,400 m; 7,870 feet): a series of 52 patients. Chest 2003; 123: 49-53 DOI: 10.1378/chest.123.1.49. (PMID: 12527602)
• 12 Tannheimer M, Lechner R. The correct measurement of oxygen saturation at high altitude. Sleep Breath 2019; 23: 1101-1106 DOI: 10.1007/s11325-019-01784-9. (PMID: 30701422)
• 13 Tannheimer M, van der Spek R, Brenner F. et al. Oxygen saturation increases over the course of the night in mountaineers at high altitude (3050–6354 m). J Travel Med 2017; 24 DOI: 10.1093/jtm/tax041. (PMID: 28931132)
• 14 Wu J, Han X, Ke H. et al. Pulmonary embolism at extreme high altitude: a study of seven cases. High Alt Med Biol 2022; 23: 209-214 DOI: 10.1089/ham.2021.0109. (PMID: 35605091)
• 15 Burtscher M, Gatterer H, Burtscher J. et al. Extreme terrestrial environments: life in thermal stress and hypoxia. A narrative review. Front Physiol 2018; 9: 572 DOI: 10.3389/fphys.2018.00572. (PMID: 29867589)
• 16 West JB. High-altitude medicine. Am J Respir Crit Care Med 2012; 186: 1229-1237 DOI: 10.1164/rccm.201207-1323CI. (PMID: 23103737)
• 17 Küpper T, Gieseler U, Milledge J. Consensus statement of the UIAA Medical Commission, vol: 3 portable hyperbaric chambers. Intended for doctors, interested non-medical persons and trekking or expedition operators. 2008 Accessed March 09, 2023 at: https://theuiaa.org/mountain-medicine/medical-advice/
• 18 Tannheimer M, Lechner R. Initial treatment of high-altitude pulmonary edema: comparison of oxygen and auto-PEEP. Int J Environ Res Public Health 2022; 19: 16185 DOI: 10.3390/ijerph192316185. (PMID: 36498257)
• 19 Follis F, Martucci G, Arcadipane A. et al. Resuscitation for moribund alpinists stranded at high altitudes: A stepwise approach including ECMO as a last resort strategy. Artif Organs 2022; 46: 1459-1462 DOI: 10.1111/aor.14320. (PMID: 35643844)