Preventive treatment of alveolar pulmonary edema of cardiogenic origin

Charach, Gideon; Shochat, Michael; Rabinovich, Alexander; Ayzenberg, Oded; George, Jacob; Charach, Lior; Rabinovich, Pavel

doi:10.3724/sp.j.1263.2012.07231

Cited by 4 publications

(8 citation statements)

References 24 publications

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“…Pleural effusion is the result of progressive accumulation of fluid in the pleural space, leading to a decrease of pulmonary bio impedance. The significance of the current study, unlike earlier ones that dealt with the diagnosis of pleural effusion [ 8 – 21 ], is that its results demonstrate that continuous ITI monitoring of patients with pulmonary effusion is a highly precise method for diagnosis and for predicting respiratory deterioration, with the intent of implementing appropriate preventive therapeutic management in the future.…”

Section: Discussionmentioning

confidence: 93%

“…Patients with pleural effusion were treated either conservatively (mainly based on the diuretics furosemide and Aldospirone) or by right lung pleural paracentesis. Monitoring of pleural effusion was carried out by placing three electrodes in the front and three electrodes in the back of the right thorax [ 8 ]. The result is the value of internal thoracic electrical resistance (impedance), the ITI.…”

Section: Methodsmentioning

confidence: 99%

“…The result is the value of internal thoracic electrical resistance (impedance), the ITI. The method by which ITI is estimated is described in detail elsewhere [ 8 , 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…However, since these methods are invasive and not suitable for widespread use [ 9 ], they are seldom employed for the detection of pulmonary effusion [ 2 – 7 ]. The changes in the blood and extravascular fluid content in the lungs in humans and animals can be easily monitored by a noninvasive procedure based on impedance plethysmography of the right lung [ 8 – 15 ]. Total transthoracic impedance (TTI) consists of ITI and skin contact impedance.…”

Section: Introductionmentioning

confidence: 99%

“…One impedance monitor, the Edema Guard Monitor (EGM) model RS-207 (R. S. Medical Monitoring, Jerusalem, Israel [ 12 ]), unlike the other currently available impedance monitors, measures only the ITI of the right lung, which roughly equals lung impedance, by automatically calculating skin electrode impedance and subtracting it from the TTI [ 8 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Internal Thoracic Impedance - A Useful Method for Expedient Detection and Convenient Monitoring of Pleural Effusion

et al. 2015

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Measurement of internal thoracic impedance (ITI) is sensitive and accurate in detecting acute pulmonary edema even at its preclinical stage. We evaluated the suitability of the highly sensitive and noninvasive RS-207 monitor for detecting pleural effusion and for demonstrating increased ITI during its resolution. This prospective controlled study was performed in a single department of internal medicine of a university-affiliated hospital between 2012-2013. One-hundred patients aged 25–96 years were included, of whom 50 had bilateral or right pleural effusion of any etiology (study group) and 50 had no pleural effusion (controls). ITI, the main component of which is lung impedance, was continuously measured by the RS-207 monitor. The predictive value of ITI monitoring was determined by 8 measurements taken every 8 hours. Pleural effusion was diagnosed according to well-accepted clinical and roentgenological criteria. During treatment, the ITI of the study group increased from 32.9±4.2 ohm to 42.8±3.8 ohm (p<0.0001) compared to non-significant changes in the control group (59.6±6.6 ohm, p = 0.24). Prominent changes were observed in the respiratory rate of the study group: there was a decrease from 31.2±4.0 to 19.5±2.4 ohm (35.2%) compared to no change for the controls, and a mean increase from 83.6±5.3%-92.5±1.6% (13.2%) in O2 saturation compared to 94.2±1.7% for the controls. Determination of ITI for the detection and monitoring of treatment of patients with pleural effusion enables earlier diagnosis and more effective therapy, and can prevent hospitalization and serious complications, such as respiratory distress, and the need for mechanical ventilation.Trial RegistrationThe study is registered at ClinicalTrials.gov NCT01601444

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

“…The result is the value of internal thoracic electrical resistance (impedance), the ITI. The method by which ITI is estimated is described in detail elsewhere [ 8 , 15 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Internal Thoracic Impedance - A Useful Method for Expedient Detection and Convenient Monitoring of Pleural Effusion

et al. 2015

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Bioelectrical impedance spectroscopy as a fluid management system in heart failure

et al. 2014

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Episodes of hospitalization for heart failure patients are frequent and are often accompanied by fluid accumulations. The change of the body impedance, measured by bioimpendace spectroscopy, is an indicator of the water content. The hypothesis was that it is possible to detect edema from the impedance data. First, a finite integration technique was applied to test the feasibility and allowed a theoretical analysis of current flows through the body. Based on the results of the simulations, a clinical study was designed and conducted. The segmental impedances of 25 patients suffering from heart failure were monitored over their recompensation process. The mean age of the patients was 73.8 and their mean body mass index was 28.6. From these raw data the model parameters from the Cole model were deduced by an automatic fitting algorithm. These model data were used to classify the edema status of the patient. The baseline values of the regression lines of the extra- and intracellular resistance from the transthoracic measurement and the baseline value of the regression line of the extracellular resistance from the foot-to-foot measurement were identified as important parameters for the detection of peripheral edema. The rate of change of the imaginary impedance at the characteristic frequency and the mean intracellular resistance from the foot-to-foot measurement were identified as important parameters for the detection of pulmonary edema. To classify the data, two decision trees were considered: One should detect pulmonary edema (n(pulmonary) = 13, n(none) = 12) and the other peripheral edema (n(peripheral) = 12, n(none) = 13). Peripheral edema could be detected with a sensitivity of 100% and a specificity of 90%. The detection of pulmonary edema showed a sensitivity of 92.31% and a specificity of 100%. The leave-one-out cross-validation-error for the peripheral edema detection was 12% and 8% for the detection of pulmonary edema. This enables the application of BIS as an early warning system for cardiac decompensation with the potential to optimize patient care.

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The Usefulness of Monitoring Pleural Effusion Treatment by the Internal Thoracic Impedance Method

2015

JCCR

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The Edema Guard Monitor (EGM) model Jerusalem, Israel [12], in contrast to the other currently available impedance monitors, measures the ITI of the right lung, which roughly equals lung impedance, by automatically calculating skin electrode impedance and subtracting it from Research Article AbstractBackground: Internal thoracic impedance (ITI) is a sensitive and reliable method used to detect pulmonary fluids accumulation as, pulmonary edema or pleural effusion. The current study deals with this noninvasive method in heart failure patients, its usefulness in detecting pleural effusion before the appearance of clinical symptoms and for demonstrating increased ITI during its resolution. Methods:A prospective controlled study performed in a single department of internal medicine belonging to a university-affiliated hospital between the years -2012-2013. Sixty two patients (ages ranging from 41 to 94) were recruited for the study, of whom 31 with bilateral or right pleural effusion of any etiology (study group) and 31without pleural effusion (control group) who were admitted because of heart failure (HF). ITI was continuously measured by the RS-207 monitor. The predictive value of ITI monitoring was determined by 8 measurements taken every 8 hours. Pleural effusion was diagnosed and followed by main clinical signs and also chest X ray as a gold standard modality before and at the end of the monitoring. Results:During the 56 hours of treatment, the median ITI of the study group increased by 21.5% -from 33.1±4.2 to 42.1±3.9 ohm (P < 0.001) as compared to the non significant changes in the control group 59.4±5.2 (P = NS). Prominent changes were observed in the respiratory rate (RR) of the study group: there was a decrease from 31.2±4.2to 19.7±2.3 (36.5%) -as compared to no changes for the controls, and a mean increase of elevation from 83.5±5.3% (9.1%) in O2 saturation to 92.4±1.5% as compared to94.3±2.1 (p-NS) for the controls. Conclusion:ITI methodology is useful for the diagnosis and monitoring of treatment of HF patients with pleural effusion as it enables diagnosis in the preclinical stage. ITI may provide early and better treatment, and can prevent complications such as respiratory distress, intubation and make hospitalization unnecessary. There were no significant ITI changes in HF patients as compared to the mixed general population.

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Preventive treatment of alveolar pulmonary edema of cardiogenic origin

Cited by 4 publications

References 24 publications

Internal Thoracic Impedance - A Useful Method for Expedient Detection and Convenient Monitoring of Pleural Effusion

Internal Thoracic Impedance - A Useful Method for Expedient Detection and Convenient Monitoring of Pleural Effusion

Bioelectrical impedance spectroscopy as a fluid management system in heart failure

The Usefulness of Monitoring Pleural Effusion Treatment by the Internal Thoracic Impedance Method

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