A 56-year-old climber with severe dyspnea, pink frothy sputum, and bilateral rales at a high altitude is suspected of high-altitude pulmonary edema. Which management strategy is most appropriate?

• A. Rapid descent, application of PEEP
• B. Administer high-flow oxygen only
• C. Administer diuretics and rest
• D. Ascend to lower altitude slowly

Answer: (A)

High-altitude pulmonary edema occurs from hypoxia-induced pulmonary vasoconstriction that raises capillary pressures and drives fluid into the alveoli. The most effective immediate intervention is to get the patient to a lower altitude as quickly as possible to reduce the hypoxic stress and pulmonary vascular pressure. While descending, providing supplemental oxygen improves the gradient for oxygen diffusion and helps every bit of alveolar oxygenation. If available, applying positive end-expiratory pressure helps keep the airways open and improves oxygenation by recruiting collapsed alveoli, which is crucial in a patient with pulmonary edema and severe dyspnea.

Diuretics are not first-line here because the edema is from capillary leak rather than fluid overload; they don’t rapidly reverse the process and can cause volume depletion. Ascending to a lower altitude slowly would prolong the hypoxic exposure and worsen the edema. So rapid descent combined with PEEP (to optimize oxygenation) is the most appropriate management in this scenario.