Alcohol vapor by inhalation in the treatment of acute pulmonary edema.

Accepted therapy of pulmonary edema is contraindicated in shock, central nervous system lesions, or pregnancy. Diagnosis of the underlying disease is not always immediately possible. Alcohol inhalation, previously tested in animals, changes surface tension of the foam and has beneficial effects. Clinical experience has revealed prompt relief in over one-half of the acute cases, definite improvement in another 29 per cent. Som'e cases with subacute edema also exhibited decreased foaming. The absence of contraindications and the possibility of using the method in conjunction with other procedures are favorable elements of alcohol therapy by inhalation. N t_'OTWITHSTANDING conventional therapy, mortality associated with acute pulmonary edema remains high. The need for other generally applicable methods of treatment is evident. In evaluating such new procedures, the following factors should be considered: (a) Possibility of Shock. Several types of acute pulmonary edema occur in conditions where there is impending shock, whether car-diogenic (myocardial infarct, extreme brady-cardia of A-V block) or peripheral (trauma, burns, certain cases of brain lesions). Among the accepted therapeutic procedures are the tise of, morphine,'-3 phenobarbital and other barbiturates,'-3 chloral hydrate,'-3 spinal anesthesia ,4 venesection, mercurial diuretics, and positive pressure respiration.' One of the main effects of these procedures is to decrease venous return'-' which may be followed by irreversible shock. (b) Central Nervous System Lesion. Other types of acute pulmonary edema are associated with injury to or lesions of the central nervous system (cerebral hemorrhage, thrombosis , or embolism; subarachnoid hemorrhage; poliomyelitis; tetanus; skull fracture). Anesthetics and sedatives are generally contrain-dicated because they may cause respiratory paralysis or shock. (c) Pregnancy. Acute pulmonary edema may complicate pregnancy-or labor. Large doses of morphine and mercurials might be detrimental to the fetus. For these reasons, one of us studied a new approach based on the use of antifoaming agents by inhalation and demonstrated its favorable action in experimental pulmonary edema.0' 11 The present study reports the first results of similar treatment in man. PART I. METHODS OF CLINICAL ADMINISTRATION AND DETERMINATION OF TOLERATION OF ALCOHOL BY INHALATION Before attempting to administer alcohol by inhalation to patients with acute pulmonary edema, it was necessary to determine the best method for use in man and to establish the toleration of this procedure by normal subjects and cardiac patients. Procedure Six normal subjects, two postoperative patients, and two cardiac patients were selected for this preliminary study. Blood tests for alcohol content in the blood serum …