Is severe re-expansion pulmonary edema still a lethal complication of closed thoracostomy or thoracic surgery?

Abstract

Background: Re-expansion pulmonary edema (REPE) is a lethal complication that can occur after inserting a chest tube. However, no clinical research reports have analyzed the progress and treatment of REPE, except for a single case report review. We retrospectively analyzed the common clinical characteristics, clinical progress, and treatment outcome of REPE with respiratory failure.Methods: We retrospectively reviewed the clinical features, treatment, and outcomes of eight patients with REPE who required ventilator care from March 2004 to March 2018. Results:The mean PaO 2 /FiO 2 ratio of the patients immediately after intubation was 106.5±20.2 (range, 75-128), which indicated severe hypoxia in all cases. On the first day of treatment, most of the patients showed improvement in hypoxia symptoms, and most improved to the extubation level on day 3. The mean duration of ventilator use was 2.5±0.8 days (range, 1-4 days), and the mean duration of inotropic drug use was 1.1±0.7 days (range, 0-2 days). The mean intensive care unit (ICU) stay was 4.4±1.5 days (range, 3-8 days). No deaths were recorded during the study period, and no cases of permanent complications due to REPE were observed.Conclusions: REPE requiring ventilator care is a lethal disease. However, continued development of ICU care has dramatically decreased mortality. Low positive end-expiratory pressure (PEEP), low tidal and high O 2 ventilator care represents the most appropriate treatment for REPE.

Risk factors for re-expansion pulmonary edema following chest tube drainage in patients with spontaneous pneumothorax: A systematic review and meta-analysis

“…Consequently, fluid and protein can leak into the alveoli, resulting in pulmonary edema. 20,21 Size of pneumothorax is a strong predictor of RPE. When the lung collapses due to a pneumothorax, the volume of air in the pleural space has been linked to the risk of RPE.…”