RE-EXPANSION PULMONARY

EDEMA
Awan Rochaniawan
 CASE
• A 49-year-old man presented to the emergency department
with sudden onset of shortness of breath 5 days prior to
admission.
• A left-sided pneumothorax was suspected on clinical
examination, and chest X-ray (CXR) confrmed a large, left-sided
pneumothorax. A 12 French gauge chest drain was inserted and
connected to an underwater seal.
• Shortly after insertion of the drain, the patient’s condition
deteriorated rapidly with tachypnea and severe hypoxemia. A
diagnosis of reexpansion pulmonary edema was made, and the
patient was treated with high-fow oxygen and continuous
positive airways pressure (CPAP).
 DEFINITION
• Re-expansion pulmonary edema (REPE) is an
uncommon complication that occurs in
patients suffering from lung collapse,
especially in cases of extensive and long-term
pneumothorax or pleural effusion.
• It is a rare but potentially fatal (mortality up to
20%) complication of the rapid removal of air,
fluid, or other space-occupying lesion from the
pleural cavity.
 PATHOPHYSIOLOGY
• The precise pathophysiology underlying re-
expansion pulmonary oedema has not been
clearly established, but alterations of vascular
permeability and hydrostatic mechanisms are
thought to be involved.
• Histological abnormalities of the pulmonary
microvessels as well as mechanical stress
exerted during reexpansion are implicated in
the pathogenesis of this disorder.
 RISK FACTORS
1. Pulmonary collapse for longer than 1 week
2. Rapid removal of a large amount of pleural
fluid over a short time period  the
recommended rate of removal of 1–2 L
every 2 h should not be exceeded.
 TREATMENT
• A good outcome can be expected from
symptomatic therapy and procedures that reduce the
level of mechanical stress during reexpansion.
• Treatment is generally conservative and supportive.
• British Toracic Society (BTS) guidelines recommend
stopping pleural aspiration when
– no more fluid or air can be aspirated,
– the patient develops symptoms of cough or chest
discomfort, or
– 1.5 L has been withdrawn.
THANK YOU
 REFERENCES
• Petiot, A., Tawk, S., & Ghaye, B. (2018). Re-expansion
pulmonary oedema. The Lancet, 392(10146), 507.
doi:10.1016/s0140-6736(18)31722-7
• Chakraborty, P., Chakraborty, S. (2012). Indian Journal of
Surgeon 74(2):174–176. doi: 10.1007/s12262-011-0258-x
• Zabielna J Med Case Reports (2021) 15:510
https://doi.org/10.1186/s13256-021-03112-w
• He Fang, Long Xu, Feng Zhu, Zhaofan Xia, Re-expansion
pulmonary edema post-pneumothorax, Burns & Trauma,
Volume 8, 2020, tkaa032,
https://doi.org/10.1093/burnst/tkaa032