REEXPANSION PULMONARY EDEMA AND ITS TREATMENT APPROACHES

Background – Reexpansion pulmonary edema (RPE), a rare complication of the reexpansion of a collapsed lung, typically follows the evacuation of a massive pleural effusion or complete pneumothorax. The aim of this study was to determine the clinical features, outcome, and effective treatment approach of RPE and also to evaluate the correlation of this phenomenon and its outcome with the underlying cause of lung collapse. Methods – This retrospective descriptive study was carried on 389 cases of chest intubation in 4 subsets of patients with the following underlying conditions: pneumothorax (200 patients), pleural effusion (100 patients), chylothorax (9 patients), and atelectasis (80 patients). Demography and data of variables were extracted from the hospital case records of the patients admitted within a 67-month period (from January 1993 to March 1998) in Thoracic Surgery Department of Razi Hospital and Cardiac Surgery Department of Heshmat Cardiovascular Center, Rasht, Iran. The statistical significance of the association between RPE and its underlying condition or treatment was assessed using χ2 analysis and Fisher’s exact test; p < 0.05 was considered significant. Results – Among 389 cases of lung collapse including 200 pneumothorax, 100 pleural effusion, 9 chylothorax, and 80 atelectasis patients, 20 cases (5.1%) were complicated with RPE. Fifteen patients (75%) had severe and 5 patients (25%) showed mild tachypnea. All pleural effusion cases, 70% of pneumothorax, and 50% of atelectasis cases severe tachypnea. In eighty percent of the RPE cases the complication appeared within the first hour of chest tube insertion while in the remaining 20%, RPE occurred within the first 24 hours. One of the patients with RPE who was a case of pneumothorax died (5% mortality). All patients were given oxygen and 14 patients (70%) received corticosteroids. Indomethacin suppositories were administered to 11 (55%) patients. Twenty-five percent of RPE cases required bronchodilators while only one case (5%) had received a bronchodilator drug. Conclusion – We concluded that RPE is not a rare complication. Early diagnosis and appropriate approach can reduce mortality. For patients with progressive hypoxemia and respiratory distress, the main aim of the treatment should be slowing the blood flow towards the involved lung; the simplest and quickest way to achieve this is lung recollapse. Meanwhile, appropriate hemodynamic monitoring, adequate fluid replacement, use of diuretics, and mechanical ventilation would be helpful.