Acute pulmonary edema may be associated with the most varied clinical conditions including cardiovascular, renal, cerebral, and pulmonary diseases, trauma to the skull or chest, infections, and shock. Many drugs and physical means have been employed in the treatment of this syndrome. Two main clinical types of pulmonary edema may be differentiated because of the different effect of therapy in each of them. Antifoaming therapy, a purely symptomatic method of treatment, tends to break a vicious circle and may be lifesaving. It should be employed initially while the patient is being examined and drugs or other remedies are being selected for possible additional treatment.
The increasing use of hypothermia by surgeons has awakened the interest of physiologists and cardiologists in the effects of lowering body temperature upon the heart. In spite of a numerous literature on the subject, it was considered that a new experimental study, by means of electro- and phonocardiography, would be of interest.
The effect of several antifoaming agents by inhalation in preventing paroxysmal pulmonary edema was tested in a series of rabbits. Three single agents (silicone aerosol, freon, and ethyl alcohol vapor) proved beneficial; their combination did not enhance the beneficial effect. A new agent (silicone aerosol) and a new combination (10 per cent ether in alcohol by aerosol) are now ready for clinical triiil.A NTIFOAMING agents in paroxysmal / % pulmonary edema were advocated in J. A . 1950 by one of us (A.A.L.) following animal experimentation.1 Several substances having effect on surface tension were tested including ether, octyl alcohol, capryl alcohol, sorbitan trioleate, and ethyl alcohol. Pulmonary edema was induced in rabbits by intravenous injection of epinephrine while the various substances were administered by inhalation by means of an atomizer.Further experiments were conducted in experimental pulmonary edema of the rat caused by intraperitoneal injection of thiourea, in pulmonary edema of the guinea pig caused by ingestion of ammonium chloride, and in pulmonary edema of the dog caused by rapid intracarotid infusion of physiologic salt solution. 2The general conclusion was that the heavy alcohols failed to develop any favorable effect, that ether had a moderate beneficial action, and that ethyl alcohol exerted an important favorable effect. This effect was attributed to modification of the surface tension of the foam followed by decrease of its volume and better oxygenation of the lungs. As systemic effects of the inhaled alcohol vapor were minimal, the method was particularly indicated for patients with pulmonary edema in shock or for those who might develop this syndrome. In the meantime, several antifoaming agents were compared in vitro by Rosenbluth and associates. Received for publication May 9, 1955. silicone in ether was beneficial in pulmonary edema induced by epinephrine in rabbits. Silicone in water emulsion was further tried in the same type of experimental pulmonary edema by Howell and co-workers, 8 apparently with good effects. The utility of silicone aerosols was further demonstrated by Curry and Nickerson" in experimental pulmonary edema of the rabbit (epinephrine) and rat (chlorine). Studies in clinical cases by means of alcohol vapor were reported
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