Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2019; 7(8): 951-960
Published online Apr 26, 2019. doi: 10.12998/wjcc.v7.i8.951
Non-invasive home lung impedance monitoring in early post-acute heart failure discharge: Three case reports
Edita Lycholip, Eglė Palevičiūtė, Ina Thon Aamodt, Ragnhild Hellesø, Irene Lie, Anna Strömberg, Tiny Jaarsma, Jelena Čelutkienė
Edita Lycholip, Eglė Palevičiūtė, Jelena Čelutkienė, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania
Edita Lycholip, Eglė Palevičiūtė, Jelena Čelutkienė, Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius 08661, Lithuania
Ina Thon Aamodt, Faculty of Medicine, Institute of Health and Society, Department of Nursing Science, University of Oslo, Oslo 0318, Norway
Ina Thon Aamodt, Irene Lie, Center for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo 0420, Norway
Ragnhild Hellesø, Departamento of Nursing Science, Institute of Health and Society, University of Oslo, Oslo 0318, Norway
Anna Strömberg, Department of Medical and Health Sciences, Linkoping University, Linkoping 58185, Sweden
Tiny Jaarsma, Department of Social and Welfare Studies, Linkoping University, Norrkoping 58185, Sweden
Author contributions: Lycholip E and Čelutkienė J were involved in diagnostics, treatment and follow-up of the patients; Lycholip E, Čelutkienė J, Palevičiūtė E, Strömberg A, Lie I, Aamodt IT, Hellesø R and Jaarsma T interpreted the patients’ data and drafted the manuscript; Lycholip E and Čelutkienė J prepared the figures; all authors contributed to writing and editing the manuscript for important intellectual content; all authors have read and approved the final manuscript.
Supported by the NordForsk “ Nordic Programme on Health and Welfare” , No. 76015.
Informed consent statement: Written informed consent forms were obtained from these patients for participating in the “Nordic Programme on Health and Welfare.” Copies of the written consent forms are available for review by the Editor of this journal.
Conflict-of-interest statement: The authors declare that they have no conflict of interests.
CARE Checklist (2016) statement: All authors have read the CARE checklist (2016) and prepared and revised the manuscript in accordance with the CARE checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Edita Lycholip, PhD, Chief Nurse, Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariskiu-2, Vilnius 08661, Lithuania. edita.lycholip@santa.lt
Telephone: +370-688-62459 Fax: +370-5250-1742
Received: December 20, 2018
Peer-review started: December 20, 2018
First decision: January 12, 2019
Revised: February 15, 2019
Accepted: February 26, 2019
Article in press: February 26, 2019
Published online: April 26, 2019
Processing time: 127 Days and 18.4 Hours
Abstract
BACKGROUND

Patients discharged after hospitalization for acute heart failure (AHF) are frequently readmitted due to an incomplete decongestion, which is difficult to assess clinically. Recently, it has been shown that the use of a highly sensitive, non-invasive device measuring lung impedance (LI) reduces hospitalizations for heart failure (HF); it has also been shown that this device reduces the cardiovascular and all-cause mortality of stable HF patients when used in long-term out-patient follow-ups. The aim of these case series is to demonstrate the potential additive role of non-invasive home LI monitoring in the early post-discharge period.

CASE SUMMARY

We present a case series of three patients who had performed daily LI measurements at home using the edema guard monitor (EGM) during 30 d after an episode of AHF. All patients had a history of chronic ischemic HF with a reduced ejection fraction and were hospitalized for 6–17 d. LI measurements were successfully made at home by patients with the help of their caregivers. The patients were carefully followed up by HF specialists who reacted to the values of LI measurements, blood pressure, heart rate and clinical symptoms. LI reduction was a more frequent trigger to medication adjustments compared to changes in symptoms or vital signs. Besides, LI dynamics closely tracked the use and dose of diuretics.

CONCLUSION

Our case series suggests non-invasive home LI monitoring with EGM to be a reliable and potentially useful tool for the early detection of congestion or dehydration and thus for the further successful stabilization of a HF patient after a worsening episode.

Keywords: Heart failure; Home monitoring; Lung impedance; Case report; Pulmonary congestion

Core tip: The monitoring of lung impedance (LI) using the edema guard monitor (EGM) seems to be a very sensitive tool for detecting an early increase in lung fluid volume. Non-invasive daily monitoring of LI with the EGM consistently reflects the changes in the dose of diuretics and responds to other treatment adjustments. The titration of the diuretic dose, according to LI values, may optimize patient stabilization in the early post-discharge period.