Preventive treatment of alveolar pulmonary edema of cardiogenic origin.
OBJECTIVE
To evaluate the efficacy of preventive treatment (PT) on alveolar pulmonary edema (APE) of cardiogenic origin using a monitor based on principles of internal thoracic impedance (ITI) measurements.


METHODS
We conducted blinded clinical trials on patients with ST-elevation myocardial infarction (STEMI) and monitored whether the condition would progress to APE. ITI was measured non-invasively by the Edema Guard Monitor (EGM, model RS-207) every 30 min. The measurement threshold for the diagnosis of APE was fixed at > 12% decrease in ITI from baseline as described in our methodology. The patients were divided into one group that received standard treatment after the appearance of clinical signs of APE without considering the prediction of APE by EGM devise (Group 1), and another group of asymptomatic patients in whom development of APE was predicted by using only EGM measurements (Group 2). The latter participants' PT consisted of furosemide, intravenous nitroglycerine and supplemental oxygen.


RESULTS
One-hundred and fifty patients with acute STEMI were enrolled into this study. Group 1 included 100 patients (53% males, age 64.1 ± 12.6 years). Treatment was started after the clinical appearance of overt signs of APE. Group 2 included 50 patients (54% males, age 65.2 ± 11.9 years) who received PT based on EGM measurements. Group 2 had significantly fewer cases of APE (n = 4, 8%) than Group 1 (n = 100, 100%) (P > 0.001). While APE was lethal in six (6%) Group 1 patients, PT resulted in prompt resolution of APE in all four (8%) Group 2 patients.


CONCLUSIONS
ITI is a useful modality for early diagnosis and PT of pulmonary edema of cardiogenic origin.
Department of Internal Medicine "C", Tel Aviv Sourasky Medical Center, 6 Weizman Street Tel Aviv 64239, Israel.
Gideon
G
Charach
Michael
M
Shochat
Alexander
A
Rabinovich
Oded
O
Ayzenberg
Jacob
J
George
Lior
L
Charach
Pavel
P
Rabinovich
Cardiogenic pulmonary edema; Early prediction; Internal thoracic impedance; Monitoring cardiac patients; Preventive treatment