Optimization Strategy for the Prevention of AMS by RIPC Combined With Acetazolamide

Study Overview
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Brief Summary
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The primary objective of the study will be to determine whether rapid remote limb ischemic preconditioning (RIPC) combined with acetazolamide can further reduce the incidence of acute mountain sickness (AMS) during the 6-hour hypoxic chamber.

Detailed Description
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The current measures to prevent acute mountain sickness (AMS) mainly include drug prevention and non-drug prevention. Acetazolamide is a drug approved by the U.S. FDA for the prevention and treatment of AMS. Remote limb ischemic preconditioning (RIPC) can also reduce the incidence of AMS as a non-durg method, with a strategy of 2 times/day training for 1 week reducing the incidence of AMS in 6 hours from 40% to 30%. The objective of this study is to determine whether rapid RIPC training combined with acetazolamide can further reduce the incidence of AMS. In this study, subjects will be divided into 5 groups: medicine group (acetazolamid 125mg bid, 2 days before entering the hypoxic room), RIPC group (RIPC training twice daily, 6 days before entering the hypoxic room), rapid RIPC group (RIPC training forth daily, 3 days before entering the hypoxic room), combined group (rapid RIPC training plus acetazolamide) and controlled group. RIPC training, completed by Renqiao Remote Ischemic Conditioning Device (Doctormate®), will be comprised of 5 cycles of bilateral upper limb ischemia and reperfusion, which will be induced by 2 cuffs placed around the upper arms respectively and inflated to 200mmHg for 5 minutes followed by 5 minutes of reperfusion by cuff deflation. After the intervention, subjects will be exposed to 4500m altitude in a normobaric hypoxic chamber for 6 hours. The incidence of AMS and other data will be compared between groups.

Official Title
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Optimization Strategy for the Prevention of Acute Mountain Sickness by Remote Ischemic Preconditioning Combined With Acetazolamide

Conditions
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Acute Mountain Sickness

Intervention / Treatment
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* Drug: Acetazolamide
* Device: Doctormate® (twice daily for 6 days)
* Device: Doctormate® (forth daily for 3 days)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: People who live in plain areas all year round and have not been to an altitude of 1500 meters or more in the past 30 days; Sign the informed consent form voluntarily. Exclusion Criteria: Chronic physical or mental diseases, including hypertension, diabetes, coronary heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, migraine, anxiety, depression, insomnia, etc.; The female is pregnant or in the period of preparing for pregnancy or breast-feeding; Have a history of smoking; Have a history of thrombosis in the upper limbs; Severe damage to local soft tissues of upper limbs, fractures, etc.; Allergic to sulfa; Are taking one or more drugs; Past laboratory tests suggest hypokalemia, hyponatremia, or liver and kidney damage; Patients unsuitable for enrollment in the clinical trial according to investigators decision making.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Medicine Group<br>Start orally take Acetazolamide 2 days before entering the hypoxic room. | Drug: Acetazolamide<br>* Start orally take acetazolamide 125mg twice daily, 2 days before entering the hypoxic chamber. Subjects will enter the hypoxic room at 9am on the third day. At that time, the subject should have taken the drug 5 times.<br>|
| Active Comparator: RIPC Group<br>Start RIPC training twice daily, 6 days before entering the hypoxic room. | Device: Doctormate® (twice daily for 6 days)<br>* Start RIPC training twice daily, 6 days before entering the hypoxic chamber. RIPC will be induced by Renqiao Remote Ischemic Conditioning Device (Doctormate®). Each training will be comprised of 5 cycles of bilateral upper limb ischemia and reperfusion, which will be induced by 2 cuffs placed around the upper arms respectively and inflated to 200mmHg for 5 minutes followed by 5 minutes of reperfusion by cuff deflation. Subjects will enter the hypoxic room at 9am on the seventh day. At that time, the subject should have finished 13 times of RIPC training.<br>|
| Experimental: Rapid RIPC Group<br>Start RIPC training forth daily, 3 days before entering the hypoxic room. | Device: Doctormate® (forth daily for 3 days)<br>* Start RIPC training forth daily, 3 days before entering the hypoxic chamber. RIPC will be induced by Renqiao Remote Ischemic Conditioning Device (Doctormate®). Each training will be comprised of 5 cycles of bilateral upper limb ischemia and reperfusion, which will be induced by 2 cuffs placed around the upper arms respectively and inflated to 200mmHg for 5 minutes followed by 5 minutes of reperfusion by cuff deflation. Subjects will enter the hypoxic room at 9am on the forth day. At that time, the subject should have finished 13 times of RIPC training.<br>|
| Experimental: Combined Group<br>Medicine + Rapid RIPC | Drug: Acetazolamide<br>* Start orally take acetazolamide 125mg twice daily, 2 days before entering the hypoxic chamber. Subjects will enter the hypoxic room at 9am on the third day. At that time, the subject should have taken the drug 5 times.<br>Device: Doctormate® (forth daily for 3 days)<br>* Start RIPC training forth daily, 3 days before entering the hypoxic chamber. RIPC will be induced by Renqiao Remote Ischemic Conditioning Device (Doctormate®). Each training will be comprised of 5 cycles of bilateral upper limb ischemia and reperfusion, which will be induced by 2 cuffs placed around the upper arms respectively and inflated to 200mmHg for 5 minutes followed by 5 minutes of reperfusion by cuff deflation. Subjects will enter the hypoxic room at 9am on the forth day. At that time, the subject should have finished 13 times of RIPC training.<br>|
| No Intervention: Control Group<br>Subjects do not receive specific interventions before entering the hypoxic room. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of acute mountain sickness. | The diagnosis of acute mountain sickness is based on '2018 Lake Louise Acute Mountain Sickness Score' , 'Acute Mountain Sickness-Cerebral Scores',etc. All subjects should finish the questionnaires to evaluate the total incidence. | 6 hours after entering the hypoxic room. | 
| The severity of acute mountain sickness. | The diagnosis of acute mountain sickness is based on '2018 Lake Louise Acute Mountain Sickness Score' , 'Acute Mountain Sickness-Cerebral Scores',etc. All subjects should finish the questionnaires to evaluate the total incidence. | 6 hours after entering the hypoxic room. | 
| Fingre pulse oximetry of the subjects. | Fingre pulse oximetry using pocket pulse oximeters will be noted. | 6 hours after entering the hypoxic room. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood pressure of the subjects. | Including systolic and diastolic pressure. | 6 hours after entering the hypoxic room. | 
| Heart rate of the subjects. |  | 6 hours after entering the hypoxic room. | 
| Respiratory rate of the subjects. |  | 6 hours after entering the hypoxic room. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute Mountain Sickness, Acetazolamide, Remote Ischemic Preconditioning