Abstract
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
Highlights
Previous studies have shown the suitability of the RS-207 monitor
Our current results revealed that the internal thoracic impedance (ITI) levels in the presence of pleural effusion were significantly lower by approximately 40% (26 ohm) compared to those of control patients without pleural effusion
We measured a 26-ohm decrease in the ITI in cases of pleural effusion. These results indicate that ab ITI measurement using RS-207 is a reliable method that may be widely applicable in clinical setting of pleural effusion
Summary
Previous studies have shown the suitability of the RS-207 monitor The currently available methods for the early detection and monitoring of pulmonary edema were not studied for pleural effusion and are not sufficiently reliable, and they themselves may lead to complications [1,2,3,4,5,6,7,8,9,10]. Yu et al [9] reported successful prediction of cardiogenic pulmonary edema (CPE) by a surgically implanted impedance plethysmograph integrated into a pacemaker. Since these methods are invasive and not suitable for widespread use [9], they are seldom employed for the detection of pulmonary effusion [2,3,4,5,6,7]. Monitors used in previous works were not sensitive enough to detect the relatively small changes in pulmonary impedance [2,3,4,5,6,7]
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