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Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
Published on: July 28, 2018
Prospective evaluation of pulmonary edema.
1Department of Internal Medicine C, Rambam Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Critical Care Medicine
|March 9, 2000
Summary
This study highlights that elderly patients with pulmonary edema often have underlying heart conditions and a high mortality rate. Left ventricular function is a key predictor of in-hospital death, emphasizing the need for comprehensive cardiac care.
Area of Science:
- Cardiology
- Internal Medicine
- Pulmonary Medicine
Background:
- Pulmonary edema is a critical condition requiring prompt medical attention.
- Understanding the clinical profile and outcomes of hospitalized patients is crucial for effective management.
- Internal medicine departments manage a significant number of pulmonary edema cases.
Purpose of the Study:
- To delineate the clinical characteristics of consecutive patients admitted with pulmonary edema.
- To assess the in-hospital outcomes, including mortality and length of stay.
- To identify predictors of mortality in hospitalized pulmonary edema patients.
Main Methods:
- Prospective, consecutive enrollment of unselected patients diagnosed with pulmonary edema.
- Data collection from patients admitted to an internal medicine department at a tertiary care center.
- Analysis of patient demographics, comorbidities, precipitating factors, interventions, and outcomes.
Main Results:
- The study included 150 elderly patients (median age 75) with common comorbidities like ischemic heart disease (85%), hypertension (70%), and diabetes (52%).
- Key precipitating factors included hypertension (29%), rapid atrial fibrillation (29%), and acute myocardial infarction (15%).
- In-hospital mortality was 12%, with cardiac pump failure as the primary cause. Predictors of mortality included diabetes, orthopnea, depressed left ventricular function, acute myocardial infarction, hypotension/shock, and mechanical ventilation requirement.
Conclusions:
- Elderly patients with pulmonary edema frequently present with multiple cardiovascular comorbidities and a history of prior edema.
- High in-hospital mortality (12%) is strongly linked to impaired left ventricular systolic function.
- The substantial median hospital stay (10 days) and extensive medication use indicate a significant healthcare burden and cost.
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