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High Altitude Respiratory Distress: A RT's Personal Experience

Those who travel for business know that every now and then, you wind up away from home over a weekend.  It is unavoidable, but veteran business travelers find ways to make the best of it. 

I am a triathlete. I enjoy competition and sign up for a variety of races and fun-runs throughout the year. Prior to a trip, I like to browse the internet to find local races or running groups so I can get some exercise and socialize. 

My colleague, with whom I travel frequently, is not a runner. She runs, but only, she informs me, 'to burn off bad attitude.'  I encourage her to run more often. She has not yet picked up on the subtlety.

Recently, we wound up in Boulder, Colo. over a weekend. Neither of us was pleased to lose a weekend home, but Ms. Attitude was particularly miffed. Prior to the trip, I had searched for some sporting event to make the weekend more enjoyable. I found two: The Mount Evans Ascent and the Father's Day 4K, on Saturday and Sunday respectively, and I signed up for both. Ms. Attitude told me she planned on sleeping late and then catching up on emails and office paperwork, so I was on my own.

The Colorado events were one week after I completed the Eagleman Ironman 70.3 event in Cambridge, Md. I was feeling strong and confident about performing well in Colorado and was excited about moving up in altitude from sea level; it would be a great learning experience that would test my endurance and perseverance. 

The Mount Evans Ascent is a 14.5 mile race that takes place near Idaho Springs, Colo., a short drive from Boulder. This race was my first-ever high altitude event. Running against gravity to 14,264 feet on the highest paved road in North America is a severe pulmonary stress test. 

On the flight out to Colorado, Ms. Attitude reminded me that East coast, sea-level dwellers do fine at 3,500 feet or less. Above that, we can experience high altitude pulmonary edema, and at 10,000 feet, we can experience early signs of hypoxia.  The run to the summit of Mount Evans begins at 10,000 feet.

The start of the race is at Echo Lake Campground. It is an easy to follow course. As a race official phrased it, "Simply stay on the one paved road and run up." Up being the key word.

In every long distance race, runners must reach certain mileage points by set times or they are removed from the race by event officials. At Mount Evans, reaching the 9-mile mark at 2.5 hours is a race cut off. The official cut off for the race was 14.5 miles at 4.5 hours. These cut offs are a good indication of how tough the run is and should serve as a warning to anyone who lives at sea level and has had no high altitude training or acclimation. I thought it would be easy, and it would have been, at sea level. I was not removed from the race by officials, but it was much harder than I thought to meet the 9-mile mark, and my head was spinning knowing that I was still 5.5 miles and 1414 feet from the summit.

In one of my clinical research projects, I studied this type of activity as it relates to monitoring respiratory health and wellness.  In a journal article, I wrote: "Individuals participating in extreme adventures undergo physical activity that may be dangerous under certain conditions. Such activities include high altitude hiking and mountain climbing. Individuals enduring these sports are at risk for high altitude pulmonary edema. Pulse oximetry may be useful for monitoring rate of ascent or to indicate need for supplemental oxygen."1 

It never occurred to me to carry a pulse oximeter until I was sweating and huffing my way towards the summit. I regret that I didn't take my own published recommendation because seeing the real-time feedback as I ran would have been very satisfying. (And probably a little scary, if I am honest.) 

For the RRT interested in the impact of altitude on blood gases, here is a chart that provides the calculated physiologic impact of the Mount Evans Ascent:

 

Sea Level

10,000 Feet

14,264 Feet

PaO2 mmHg

99.8

54

38

SaO2%

98

86

68

PaCO2 mmHg

37

37

37

HCO3-

24

24

24

Athletes who push the envelope with their exercise routines can experience hypoxemia even at lower altitudes. In testing elite athletes in another study, we found that blood oxygen saturation (SaPO2%) is inversely proportional to maximum oxygen consumption VO2max during increasing exercise workloads. As VO2max is approached, heart rate (HR) increases to lactic threshold heart rate and ventilatory threshold is met.2 Under these conditions, anaerobic pathways are used to compensate for the increased workload demands.  

From a respiratory therapist's point-of view, the Mount Evans Ascent was a not an immense, n = 1 experiment of pulmonary stress at altitude. However, as I made my way toward the summit, I thought a lot about what it might be like to have COPD and trying to work through daily activities. At one point I wondered if what I was experiencing was like how a heart attack would feel. I thought about the warning my colleague gave me on the plane the day before about the risks associated with going from sea level to high altitude with no time to train or acclimate. I ran past big horn sheep and mountain goats, and I noted that those animals, which live at the elevations, were not running around. I kept running up, just like the event official said to do. I ran through respiratory distress that I had never experienced before. I made it to the finish line and I will forever feel really, really good about it.

After the race, my colleague and I had dinner and prepared for our meeting on Monday. I told her all about my quest to reach the summit. I described the Big Horn Sheep and the Mountain Goats, and how they seemed to be happy just grazing lazily and hanging out on the rocky terrain. She said the sheep and goats had the right idea. She had gone for a run that afternoon, nearly passed out about a quarter mile in and decided to lay by the pool and order drinks instead.

As a respiratory therapist, if you ever get a chance, and are so inclined, grab a pulse oximeter and try running at altitude. It is very illuminating. But if you haven't trained for it and don't have the time to get acclimated, you might want to take a nod from the local wildlife and my colleague and just kick back and enjoy the spectacular environment that high altitudes have to offer. 

David Lain, PhD, JD, FCCP, RRT, RCP, is a triathlete, competitive cyclist and runner.  He has qualified for two world championships since 2007 and has had numerous podium finishes over his competitive career including two first place finishes in 2012. He is a former state champion cyclist on the road and track. He also is vice president and chief clinical officer at Oridion Capnography in Needham, Mass.

References:

1. Lain D, Shakar U. Practical pulse oximetry during high altitude hiking. Chest. 2000;118(4):203S.

2. Lain D, Jackson C. Exercise induced hypoxemia (EIH) desaturation zones: a use or athletic training. Chest. 2000:118(4):203S,.


Articles Archives
 

Nice article, made me think of how high flow therapy was originally used to treat race horses and found effective at not only treating but helping to prevent exercise-induced pulmonary hemorrhage. I wonder if breathing on a high flow nasal cannula 30-60 minutes prior to starting a race would enhance your high altitude performance?

Jonathan Waugh,  Professor,  Univ. of Alabama at BirminghamSeptember 26, 2012
Birmingham, AL



Great report, David. As a triathlete, for you to experience this is an important note for us all: when our patients travel we need to keep the "Mt. Evans" phemonenon in mind. Thanks also for the great description of the physiological context of your experience.

George  Dungan ,  DirectorSeptember 26, 2012
Dallas, TX




     

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