Aufenthalte in großen Höhen nach COVID-19-Infektion − neue Aspekte der höhenmedizinischen Beratung

Zusammenfassung

Nach Lockerung der Reisefreiheit, welche im Rahmen der COVID-19-Pandemie stark eingeschränkt war, ist mit einem wiedereinsetzenden Tourismus auch in hochgelegene Reiseziele über 2500 Meter zu rechnen.

Weiterhin kann man diesem Trend entsprechend davon ausgehen, dass Patienten mit durchgemachter COVID-19-Infektion vor der Reise in große Höhen höhenmedizinische Beratung suchen.

Hier wird der reise- und höhenmedizinisch beratende Arzt vor große Herausforderungen gestellt, da er mit dieser speziellen Fragestellung bisher nicht konfrontiert worden ist.

Dieser Artikel geht neben den Grundlagen der Höhenkrankheit und des Höhenlungenödems auf die aktuelle Studienlage pulmonologischer Pathologien und Krankheitsverläufe bei COVID-19-Infektion ein und gibt entsprechend dem aktuellen Kenntnisstand Empfehlungen zur höhenmedizinischen Beratung von Patienten nach durchgemachter COVID-19-Infektion.

Abstract

After loosening of travel restrictions due to the COVID-19 pandemic, tourism to high-altitude destinations over 2500 metres is expected to increase again.

In line with this trend, it can be expected that patients after recovery from COVID-19 infection will seek advice from specialists on altitude or travel medicine before travelling to high altitudes.

Here, the physician on altitude medicine is faced with major challenges, as such a question has not been raised so far.

In addition to the basics of altitude sickness and high altitude pulmonary edema, this article deals with the current studies on pulmonological pathologies and disease course of COVID-19 infections and, in accordance with the current state of knowledge, provides recommendations for advice in altitude medicine for patients after COVID-19 infection.

Publication History

Received: 15 July 2020

Accepted: 12 August 2020

Article published online:
05 November 2020

• Literatur

• 1 Dietz T, Hackett P. High-Altitude Medicine. In: Kozarsky PE, Connor BA, Nothdurft HD, Mendelson M, Leder K, Keystone JS. Travel Medicine (Fourth Edition). Elsevier; 2019: 387-400 ISBN: 9780323546966
• 2 Auerbach PS, Cushing TA, Harris NS. Auerbachʼs Wilderness Medicine E-book. Elsevier Health Sciences; 2016. ISBN: 9780323359429
• 3 Berghold F, Brugger H, Burtscher M. et al. Alpin-und Höhenmedizin. Springer-Verlag Berlin Heidelberg 2019;
• 4 Schommer K, Baertsch P. Basic medical advice for travelers to high altitudes. Dtsch Ärztebl Int 2011; 108: 839-848
• 5 Robert Koch Institut (RKI). Informationen zur Ausweisung internationaler Risikogebiete durch das Auswärtige Amt, BMG und BMI (7.08.2020). Im Internet: www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikogebiete_neu.html
• 6 Deutscher Alpenverein (DAV). Bergsport in Coronazeiten, Öffnungstermine der Alpenvereinshütten. Im Internet (aufgerufen am 10.07.2020): www.alpenverein.de/bergsport/aktiv-sein/bergsport-in-coronazeiten/oeffnungstermine-der-alpenvereinshuetten_aid_33489.html
• 7 Bartsch P. High altitude pulmonary edema. Med Sci Sports Exerc 1999; 31 (Suppl. 01) 23-27
• 8 Luks AM, Freer L, Grissom CK. et al. COVID-19 Lung Injury is Not High Altitude Pulmonary Edema. High Altitude Medicine & Biology 2020; 21: 192-193
• 9 Archer SL, Sharp WW, Weir EK. Differentiating COVID-19 Pneumonia from Acute Respiratory Distress Syndrome (ARDS) and High Altitude Pulmonary Edema (HAPE): Therapeutic Implications. Circulation 2020; 142: 101-104
• 10 Hanley B, Lucas SB, Youd E. et al. Autopsy in suspected COVID-19 cases. J Clin Pathol 2020; 73: 239-242
• 11 Bi Q, Wu Y, Mei S. et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study [published correction appears in Lancet Infect Dis 2020 Jul; 20(7): e148]. Lancet Infect Dis 2020; 20: 911-919
• 12 Wang T, Du Z, Zhu F. et al. Comorbidities and multi-organ injuries in the treatment of COVID-19. Lancet 2020; 395: e52
• 13 Manferdelli G, Bishop DJ, Franchi MV. et al. Recommendations for altitude training programming to preserve athletes’ health after COVID-19 pandemic. British Journal of Sports Medicine 2020;
• 14 Pun M, Turner R, Strapazzon G. et al. Lower Incidence of COVID-19 at High Altitude: Facts and Confounders. High Altitude Medicine & Biology 2020;
• 15 Arias-Reyes C, Zubieta-DeUrioste N, Poma-Machicao L. et al. Does the pathogenesis of SARS-CoV-2 virus decrease at high-altitude?. Respir Physiol Neurobiol 2020; 277: 103443
• 16 Woolcott OW, Bergman RN. Mortality Attributed to COVID-19 in High-Altitude Populations. medRxiv 2020;
• 17 Strapazzon G, Hilty MP, Bouzat P. et al. To compare the incomparable: COVID-19 pneumonia and high altitude disease. European Respiratory Journal 2020; 55: 2001362
• 18 Huang Y, Tan C, Wu J. et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res 2020; 21: 163
• 19 Deutsches Ärzteblatt. Gesundheitsministerium rechnet mit Spätfolgen nach COVID-19-Erkrankungen. Im Internet (15.05.2020): www.aerzteblatt.de/nachrichten/112936/Gesundheitsministerium-rechnet-mit-Spaetfolgen-nach-COVID-19-Erkrankungen
• 20 Carfì A, Bernabei R, Landi F. et al. for the Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA 2020; 324: 603-605
• 21 Dai H, Zhang X, Xia J. et al. High-resolution Chest CT Features and Clinical Characteristics of Patients Infected with COVID-19 in Jiangsu, China. Int J Infect Dis 2020; 106-112
• 22 Pan F, Ye T, Sun P. et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology 2020; 295: 715-721
• 23 Wang Y, Dong C, Hu Y. et al. Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study. Radiology 2020; 296: E55-E64
• 24 Corsini A, Bisciotti GN, Eirale C. et al. Football cannot restart soon during the COVID-19 emergency! A critical perspective from the Italian experience and a call for action. British Journal of Sports Medicine 2020;
• 25 Ruan Q, Yang K, Wang W. et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46: 846-848
• 26 Murdoch D. Symptoms of Infection and Altitude Illness Among Hikers in the Mount Everest Region of Nepal. Aviat Space Environ Med 1995; 66: 148-151
• 27 Basnyat B, Subedi D, Sleggs J. et al. Disoriented and ataxic pilgrims: an epidemiological study of acute mountain sickness and high-altitude cerebral edema at a sacred lake at 4300 m in the Nepal Himalayas. Wilderness Environ Med 2000; 11: 89-93
• 28 World Health Organization (WHO). WHO Director-Generalʼs opening remarks at the media briefing on COVID-19. Im Internet (23.02.2020): www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february-2020
• 29 Nieß AM, Bloch W, Friedmann-Bette B. et al. Positionspapier “Return to Sport” während der aktuellen Coronavirus-Pandemie (SARS-CoV-2/COVID-19). Dtsch Z Sportmed 2020; 71: E1-E4
• 30 Schellhorn P, Klingel K, Burgstahler C. Return to sports after COVID-19 infection: Do we have to worry about myocarditis?. European Heart Journal 2020;
• 31 Phelan D, Kim JH, Chung EH. A Game Plan for the Resumption of Sport and Exercise After Coronavirus Disease 2019 (COVID-19) Infection. JAMA Cardiology 2020;
• 32 Maron BJ, Udelson JE, Bonow RO. et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology . Circulation 2015; 32: e273-e280
• 33 Williamson EJ, Walker AJ, Bhaskaran K. et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;