Positive Pressure Ventilation Therapy for Improvement of Symptoms and Physiological Measurement in Acute Mountain Sickness: A Systematic Review and Meta-Analysis

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Mohammad Satrio Wicaksono
I Nyoman Sebastian Sudiasa
Eisya Akmel Naila



Acute mountain sickness (AMS) is a high altitude disease characterized by headache, dizziness, fatigue, and gastrointestinal symptoms. AMS leads to hypobaric hypoxia and potentially develops into dangerous conditions such as pulmonary or cerebral edema. Current pharmacological treatments such as acetazolamide, dexamethasone, and analgesics have not been proven to be consistently effective to prevent AMS and shown unpleasant adverse effects. Alternatively, positive pressure ventilation therapy has shown some promising results in treating AMS.



The aim of this systematic review and meta-analysis is to evaluate the efficacy of positive pressure ventilation therapy in improving symptoms and physiological measurement in acute mountain sickness.



This systematic review and meta-analysis was reported based on the PRISMA statement. The literature search was conducted on several databases, such as PubMed, Cochrane, Science Direct, and Scopus. Results were shown as mean difference (MD) and standard deviation (SD). A fixed-effect model (FEM) was used when the included studies were considered homogenous), which were indicated by an I2 value less than 40%. Risk of bias was assessed using the cochrane risk-of-bias tool for randomized trials (RoB 2).



This systematic review and meta-analysis included four randomized control studies with the total of 277 participants. Lake Louise Score declining with a significant pooled mean difference (MD) of -1.16 [95% CI: (-1.90) - (-0.41), P = 0.002]. Arterial oxygenation improvement with a significant pooled MD of 4.13 [95% CI: (-0.83) - 9.08, P < 0.00001]. Heart rate measurement showed no significant effect, MD of -0.19 [95% CI: (-7.26) - 6.68, P = 0.96]



This systematic review and meta-analysis showed evidence that positive pressure ventilation therapy is a prospective therapy to significantly improve acute mountain sickness symptoms and arterial oxygenation, but has no significant effect on heart rate.

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How to Cite
Wicaksono, M. S., Achmad Ivka Raehan, Sudiasa, I. N. S. and Eisya Akmel Naila (2023) “Positive Pressure Ventilation Therapy for Improvement of Symptoms and Physiological Measurement in Acute Mountain Sickness: A Systematic Review and Meta-Analysis”, Journal of Asian Medical Students’ Association. Kuala Lumpur, Malaysia. Available at: https://jamsa.amsa-international.org/index.php/main/article/view/535 (Accessed: 4February2023).
Scientific Papers (EAMSC 2023 Nepal)


Prince TS, Thurman J, Huebner K. Acute Mountain Sickness. StatPearls [Internet]. 2022 Jul 12 [cited 2022 Nov 21]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK430716/

Luks AM, Swenson ER, Bärtsch P. Acute high-altitude sickness. Eur Respir Rev [Internet]. 2017 Jan 1 [cited 2022 Nov 21];26(143). Available from: https://pubmed.ncbi.nlm.nih.gov/28143879/

Rupp T, Saugy JJ, Bourdillon N, Verges S, Millet GP. Positive expiratory pressure improves arterial and cerebral oxygenation in acute normobaric and hypobaric hypoxia. Am J Physiol Regul Integr Comp Physiol [Internet]. 2019 [cited 2022 Nov 21];317(5):R754–62. Available from: https://pubmed.ncbi.nlm.nih.gov/31530174/

Mairer K, Wille M, Burtscher M. The prevalence of and risk factors for acute mountain sickness in the Eastern and Western Alps. High Alt Med Biol [Internet]. 2010 Dec 1 [cited 2022 Nov 21];11(4):343–8. Available from: https://pubmed.ncbi.nlm.nih.gov/21190503/

Taylor AT. High-Altitude Illnesses: Physiology, Risk Factors, Prevention, and Treatment. Rambam Maimonides Med J [Internet]. 2011 Jan 21 [cited 2022 Nov 21];2(1). Available from: /pmc/articles/PMC3678789/

Larson EB. Acute Mountain Sickness and Acetazolamide. JAMA. 1982 Jul 16;248(3):328.

Hackett PH, Roach RC. High-Altitude Illness. New England Journal of Medicine. 2001 Jul 12;345(2):107–14.

Masuet-Aumatell C, Sánchez-Mascunanõ A, Santangelo FA, Ramos SM, Ramon-Torrell JM. Relationship between Smoking and Acute Mountain Sickness: A Meta-Analysis of Observational Studies. Biomed Res Int [Internet]. 2017 [cited 2022 Nov 21];2017. Available from: https://pubmed.ncbi.nlm.nih.gov/29259975/

Bärtsch P, Swenson ER, Paul A, Jülg B, Hohenhaus E. Hypoxic ventilatory response, ventilation, gas exchange, and fluid balance in acute mountain sickness. High Alt Med Biol [Internet]. 2002 [cited 2022 Nov 21];3(4):361–76. Available from: https://pubmed.ncbi.nlm.nih.gov/12631422/

Roach RC, Greene ER, Schoene RB, Hackett PH. Arterial oxygen saturation for prediction of acute mountain sickness. Aviat Space Environ Med. 1998 Dec;69(12):1182–5.

Acosta P, Santisbon E, Varon J. “The use of positive end-expiratory pressure in mechanical ventilation.” Crit Care Clin [Internet]. 2007 Apr [cited 2022 Nov 21];23(2):251–61. Available from: https://pubmed.ncbi.nlm.nih.gov/17368169/

Tannheimer M, Tannheimer S, Thomas A, Engelhardt M, Schmidt R. Auto-PEEP in the therapy of AMS in one person at 4,330 m. Sleep Breath [Internet]. 2009 [cited 2022 Nov 21];13(2):195–9. Available from: https://pubmed.ncbi.nlm.nih.gov/19052788/

Lipman GS, Kanaan NC, Phillips C, Pomeranz D, Cain P, Fontes K, et al. Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID). High Alt Med Biol [Internet]. 2015 Jun 1 [cited 2022 Nov 21];16(2):154–61. Available from: https://pubmed.ncbi.nlm.nih.gov/25950723/

Savourey G, Caterini R, Launay JC, Guinet A, Besnard Y, Hanniquet AM, et al. Positive end expiratory pressure as a method for preventing acute mountain sickness. Eur J Appl Physiol Occup Physiol [Internet]. 1998 Dec 1 [cited 2022 Nov 21];77(1–2):32–6. Available from: https://pubmed.ncbi.nlm.nih.gov/9459518/

Launay JC, Nespoulos O, Guinet-Lebreton A, Besnard Y, Savourey G. Prevention of acute mountain sickness by low positive end-expiratory pressure in field conditions. Scand J Work Environ Health [Internet]. 2004 [cited 2022 Nov 21];30(4):322–6. Available from: https://pubmed.ncbi.nlm.nih.gov/15458016/

Johnson PL, Popa DA, Prisk GK, Edwards N, Sullivan CE. Non-invasive positive pressure ventilation during sleep at 3800 m: Relationship to acute mountain sickness and sleeping oxyhaemoglobin saturation. Respirology [Internet]. 2010 Feb [cited 2022 Nov 21];15(2):277–82. Available from: https://pubmed.ncbi.nlm.nih.gov/20051046/

Potchileev I, Doroshenko M, Mohammed AN. Positive Pressure Ventilation. StatPearls [Internet]. 2022 May 15 [cited 2022 Nov 21]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK560916/

Roach RC, Hackett PH, Oelz O, Bärtsch P, Luks AM, MacInnis MJ, et al. The 2018 Lake Louise Acute Mountain Sickness Score. High Alt Med Biol. 2018 Mar;19(1):4–6.

Karinen HM, Peltonen JE, Kähönen M, Tikkanen HO. Prediction of acute mountain sickness by monitoring arterial oxygen saturation during ascent. High Alt Med Biol. 2010;11(4):325–32.

Nespoulet H, Rupp T, Bachasson D, Tamisier R, Wuyam B, Lévy P, et al. Positive expiratory pressure improves oxygenation in healthy subjects exposed to hypoxia. PLoS One. 2013;8(12):e85219.

Oliver SJ, Sanders SJ, Williams CJ, Smith ZA, Lloyd-Davies E, Roberts R, et al. Physiological and psychological illness symptoms at high altitude and their relationship with acute mountain sickness: a prospective cohort study. J Travel Med [Internet]. 2012 [cited 2022 Nov 21];19(4):210–9. Available from: https://pubmed.ncbi.nlm.nih.gov/22776381/

Gonggalanzi, Labasangzhu, Bjertness E, Wu T, Stigum H, Nafstad P. Acute mountain sickness, arterial oxygen saturation and heart rate among Tibetan students who reascend to Lhasa after 7 years at low altitude: a prospective cohort study. BMJ Open. 2017 Jul 10;7(7):e016460.

Bärtsch P, Gibbs JSR. Effect of altitude on the heart and the lungs. Circulation. 2007 Nov 6;116(19):2191–202.

Mallet RT, Burtscher J, Richalet JP, Millet GP, Burtscher M. Impact of High Altitude on Cardiovascular Health: Current Perspectives. Vasc Health Risk Manag. 2021 Jun;Volume 17:317–35.