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  • Title: Field Ultrasound Evaluation of Central Volume Status and Acute Mountain Sickness.
    Author: Pitman JT, Thapa GB, Harris NS.
    Journal: Wilderness Environ Med; 2015 Sep; 26(3):319-26. PubMed ID: 25864086.
    Abstract:
    OBJECTIVE: To investigate whether ultrasonography can be used for field volume status assessment and to determine whether a detectable difference in intravascular volume exists in individuals with acute mountain sickness (AMS) compared with those without. METHODS: Study was performed at the Himalayan Rescue Association Clinic in Manang, Nepal, located on the Annapurna trekking circuit at an altitude of 3519 m (11545 feet). A convenience sample was taken from individuals trekking over 5 to 8 days from 760 m (2490 feet) to 3519 m (11,545 feet), comparing asymptomatic trekkers vs those who experienced AMS. Subjects were evaluated for AMS based on the Lake Louise AMS Questionnaire (LLS ≥ 3 indicates AMS). After medical screening examination, both groups (control, n = 51; AMS, n = 18) underwent ultrasonography to obtain measurements of inferior vena cava collapsibility index (IVC CI) and left ventricular outflow tract velocity-time integral (LVOT VTI) before and after a passive leg raise (PLR) maneuver. RESULTS: There was no statistically significant difference between groups regarding change in heart rate before and after PLR, or IVC CI; however, there was a statistically significant greater increase in LVOT VTI after PLR maneuver in control group subjects compared with those with AMS (18.96% control vs 11.71% AMS; P < .01). CONCLUSIONS: Ultrasonography is a useful tool in the assessment of intravascular volume at altitude. In this sample, we found ultrasonographic evidence that subjects with AMS have a higher intravascular volume than asymptomatic individuals. These data support the hypothesis that individuals with AMS have decreased altitude-related diuresis compared with asymptomatic individuals.
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