Preventive treatment of alveolar pulmonary edema of cardiogenic origin
Preventive treatment of alveolar cardiogenic pulmonary edema

AIM: To evaluate the efficacy of preventive alveolar cardiogenic pulmonary edema (ACPE). MATERIALS AND METHODS: We conducted blinded clinical trials on patients with ST-elevated myocardial infarction and predicted whether the condition would progress to ACPE. Right lung internal thoracic impedance (ITI) was measured noninvasively every 30 minutes. The threshold for ACPE was fixed as a >12% decrease of ITI from baseline. Traditional treatment was administered after the appearance of clinical signs of ACPE, including dyspnea, cyanosis, rales, crepitation and rhonchus in lungs, arterial hypoxemia, as well as radiographic evidence of ACPE (Group 1). Preventive treatment (PT) was administered to the patients whose development of edema was predicted by the Edema Guard Monitor (EGM model RS-207, RS Medical Monitoring Ltd, Jerusalem, Israel) in the absence of clinical and X-ray signs (Group 2). The clinicians and radiologists were unaware of the patients’ group assignment. RESULTS: One-hundred and fifty patients with ST-elevated acute myocardial infarction were recruited for this study. Excluded were patients with extra-cardiac respiratory failure or chest deformations. Group 1 was comprised of 100 patients (53% males, mean age 64.1 ± 12.6years, range 51-76) whose treatment was initiated after the appearance of clinical signs of ACPE. Group 2 was comprised of 50 patients (54% males, mean age 65.2 ± 11.9 years, range 53-77) who received preventive PT. After Edema Guard Monitor predicted ACPE successfull PT is expected to result in fewer cases of ACPE development in the second group as compared to the first group. Indeed, all group 1 patients developed ACPE which was lethal for six of them (6%, P < 0.05). Four Group 2 patients developed ACPE (1 moderate and 3 mild) (8%, P < 0.001). CONCLUSION: Right lung monitoring by the EGM alerted to the indication of PT which efficaciously inhibited the development of ACPE.