PMID- 28653390

OWN - NLM
STAT- MEDLINE
DCOM- 20170824
LR - 20190428
IS - 1469-493X (Electronic)
IS - 1361-6137 (Linking)
VI - 6
DP - 2017 Jun 27
TI - Interventions for preventing high altitude illness: Part 1. Commonly-used
classes
of drugs.
PG - CD009761
LID - 10.1002/14651858.CD009761.pub2 [doi]
AB - BACKGROUND: High altitude illness (HAI) is a term used to describe a group of
cerebral and pulmonary syndromes that can occur during travel to elevations
above
2500 metres (8202 feet). Acute hypoxia, acute mountain sickness (AMS), high
altitude cerebral oedema (HACE) and high altitude pulmonary oedema (HAPE) are
reported as potential medical problems associated with high altitude. In this
review, the first in a series of three about preventive strategies for HAI,
we
assess the effectiveness of six of the most recommended classes of
pharmacological interventions. OBJECTIVES: To assess the clinical
effectiveness
and adverse events of commonly-used pharmacological interventions for
preventing
acute HAI. SEARCH METHODS: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL), MEDLINE (OVID), Embase (OVID), LILACS and trial
registries in January 2017. We adapted the MEDLINE strategy for searching the
other databases. We used a combination of thesaurus-based and free-text terms
to
search. SELECTION CRITERIA: We included randomized-controlled and cross-over
trials conducted in any setting where commonly-used classes of drugs were
used to
prevent acute HAI. DATA COLLECTION AND ANALYSIS: We used standard
methodological
procedures as expected by Cochrane. MAIN RESULTS: We included 64 studies (78
references) and 4547 participants in this review, and classified 12
additional
studies as ongoing. A further 12 studies await classification, as we were
unable
to obtain the full texts. Most of the studies were conducted in high altitude
mountain areas, while the rest used low pressure (hypobaric) chambers to
simulate
altitude exposure. Twenty-four trials provided the intervention between three
and
five days prior to the ascent, and 23 trials, between one and two days
beforehand. Most of the included studies reached a final altitude of between
4001
and 5000 metres above sea level. Risks of bias were unclear for several
domains,
and a considerable number of studies did not report adverse events of the
evaluated interventions. We found 26 comparisons, 15 of them comparing
commonly-used drugs versus placebo. We report results for the three most
important comparisons: Acetazolamide versus placebo (28 parallel studies;
2345
participants)The risk of AMS was reduced with acetazolamide (risk ratio (RR)
 0.47, 95% confidence interval (CI) 0.39 to 0.56; I(2) = 0%; 16 studies; 2301
participants; moderate quality of evidence). No events of HAPE were reported
and
only one event of HACE (RR 0.32, 95% CI 0.01 to 7.48; 6 parallel studies;
1126
participants; moderate quality of evidence). Few studies reported side
effects
for this comparison, and they showed an increase in the risk of paraesthesia
with
the intake of acetazolamide (RR 5.53, 95% CI 2.81 to 10.88, I(2) = 60%; 5
studies, 789 participants; low quality of evidence). Budenoside versus
placebo (2
parallel studies; 132 participants)Data on budenoside showed a reduction in
the
incidence of AMS compared with placebo (RR 0.37, 95% CI 0.23 to 0.61; I(2) =
0%;
2 studies, 132 participants; low quality of evidence). Studies included did
not
report events of HAPE or HACE, and they did not find side effects (low
quality of
evidence). Dexamethasone versus placebo (7 parallel studies; 205
participants)For
dexamethasone, the data did not show benefits at any dosage (RR 0.60, 95% CI
0.36
to 1.00; I2 = 39%; 4 trials, 176 participants; low quality of evidence).
Included
studies did not report events of HAPE or HACE, and we rated the evidence
about
adverse events as of very low quality. AUTHORS' CONCLUSIONS: Our assessment
of
the most commonly-used pharmacological interventions suggests that
acetazolamide
is an effective pharmacological agent to prevent acute HAI in dosages of 250
to
750 mg/day. This information is based on evidence of moderate quality.
Acetazolamide is associated with an increased risk of paraesthesia, although
there are few reports about other adverse events from the available evidence.
The
clinical benefits and harms of other pharmacological interventions such as
ibuprofen, budenoside and dexamethasone are unclear. Large multicentre
studies
are needed for most of the pharmacological agents evaluated in this review,
to
evaluate their effectiveness and safety.
FAU - Nieto Estrada, Victor H
AU - Nieto Estrada VH
AD - Department of Critical Care Medicine, Hospital de San Jose, Fundacion
Universitaria de Ciencias de la Salud, Bogota, Colombia.
FAU - Molano Franco, Daniel
AU - Molano Franco D
FAU - Medina, Roger David
AU - Medina RD
FAU - Gonzalez Garay, Alejandro G
AU - Gonzalez Garay AG
FAU - Marti-Carvajal, Arturo J
AU - Marti-Carvajal AJ
FAU - Arevalo-Rodriguez, Ingrid
AU - Arevalo-Rodriguez I
LA - eng
PT - Journal Article
PT - Meta-Analysis
PT - Research Support, Non-U.S. Gov't
PT - Review
PT - Systematic Review
DEP - 20170627
PL - England
TA - Cochrane Database Syst Rev
JT - The Cochrane database of systematic reviews
JID - 100909747
RN - 0 (Carbonic Anhydrase Inhibitors)
RN - 0 (Glucocorticoids)
RN - 51333-22-3 (Budesonide)
RN - 7S5I7G3JQL (Dexamethasone)
RN - O3FX965V0I (Acetazolamide)
RN - Pulmonary edema of mountaineers
SB - IM
MH - Acetazolamide/adverse effects/*therapeutic use
MH - Adolescent
MH - Adult
MH - Aged
MH - Altitude Sickness/complications/epidemiology/*prevention & control
MH - Brain Edema/epidemiology/etiology/*prevention & control
MH - Budesonide/*therapeutic use
MH - Carbonic Anhydrase Inhibitors/adverse effects/*therapeutic use
MH - Dexamethasone/adverse effects/*therapeutic use
MH - Glucocorticoids/*therapeutic use
MH - Humans
MH - Hypertension, Pulmonary/epidemiology/*prevention & control
MH - Middle Aged
MH - Paresthesia/chemically induced
MH - Publication Bias
MH - Randomized Controlled Trials as Topic
PMC - PMC6481751
EDAT- 2017/06/28 06:00
MHDA- 2017/08/25 06:00
CRDT- 2017/06/28 06:00
PHST- 2017/06/28 06:00 [pubmed]
PHST- 2017/08/25 06:00 [medline]
PHST- 2017/06/28 06:00 [entrez]
AID - 10.1002/14651858.CD009761.pub2 [doi]
PST - epublish
SO - Cochrane Database Syst Rev. 2017 Jun 27;6:CD009761. doi:
10.1002/14651858.CD009761.pub2.