A64-05 Comparative Efficacy of Pharmacologic Interventions for Preventing High-Altitude Pulmonary Edema: A Systematic Review and Network Meta-Analysis
Abstract
High-Altitude Pulmonary Edema (HAPE) is a potentially fatal, non-cardiogenic pulmonary edema affecting individuals who rapidly ascend above 2,500-3,000 meters. It results from exaggerated hypoxic pulmonary vasoconstriction, leading to elevated pulmonary pressures and alveolar capillary leakage. Several pharmacologic agents such as nifedipine, tadalafil, salmeterol, and dexamethasone have been proposed for prophylaxis, but comparative evidence remains limited. This systematic review and network meta-analysis aimed to evaluate the efficacy and safety of these agents in preventing HAPE.
A systematic search of PubMed, Scopus, Web of Science, Embase, and Cochrane Library was conducted following PRISMA 2020 guidelines. for studies evaluating the effectiveness of pharmacological prophylaxis for preventing HAPE. Only randomized controlled trials (RCTs) assessing pharmacological prevention of HAPE in adults ascending ≥2,500m were included. The primary outcome was incidence of HAPE. Risk ratios were pooled using a random-effects model with continuity correction. Heterogeneity and inconsistency were assessed, and risk of bias was evaluated using the ROB-2 tool.
A total of five studies (n = 223) met inclusion criteria. Both nifedipine and tadalafil significantly reduced the incidence of HAPE compared with placebo across all model specifications (RR = 0.20; 95% CI, 0.05-0.77 and RR = 0.20; 95% CI, 0.05-0.76, respectively). Dexamethasone also appeared protective (RR = 0.06; 95% CI,…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 223 participants or records.
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