Re-expansion pulmonary oedema after spontaneous pneumothorax treatment with chest tube placement

Rodrigues, D.M.; Valério, Margarida; Costa, Teresa

doi:10.1136/bcr-2021-241734

Cited by 4 publications

(5 citation statements)

References 6 publications

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Section: Discussionmentioning

confidence: 84%

“…Risk factors of REPE include young age (<40 years old), large pneumothorax (>30%) or large amount pleural effusion, long duration of symptoms and lung collapse (>3 days), rapid re-expansion of the lungs (<10 min), and the pleural effusion drainage of 1.5 L or more at once and negative pressure suction drainage. [ 1 , 4 , 6 , 9 ] The patient in this case had risk factors such as age (27 years old), total collapse, and long duration of symptoms (7 days). Therefore, it is important to accurately listen to the patient's medical history, including the period of onset of symptoms, and if a patient has these risk factors, efforts should be provided to expand the lungs slowly.…”

Section: Discussionmentioning

confidence: 99%

“…Re-expansion pulmonary edema (REPE) occurs when a collapsed lung rapidly re-expands for a short time after chest tube insertion to treat pneumothorax, pleural effusion, or hemothorax, but its exact pathophysiology is unclear. [1][2][3] REPE is a rare complication with an incidence of <1% in pneumothorax, but a mortality rate of up to 20%, and so it is very fatal. [3][4][5] Therefore, it is necessary to recognize the occurrence of REPE early and perform appropriate treatments.…”

Section: Introductionmentioning

confidence: 99%

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Severe re-expansion pulmonary edema after chest tube insertion for the treatment of spontaneous pneumothorax

Song¹

2021

Medicine

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Rationale: Re-expansion pulmonary edema (REPE) is a rare complication after chest tube insertion for the treatment of spontaneous pneumothorax. However, this complication can be life threatening when it occurs. Therefore, it is necessary to recognize REPE early and treat it appropriately. In the present study, we report a severe REPE case occurring after chest tube insertion in a patient with spontaneous pneumothorax. Patient concerns: A 27-year-old male patient visited out hospital with chest pain on the left, which had started a week ago. After diagnosed with pneumothorax and having chest tube insertion, the patient complained of sudden shortness of breath, persistent cough, foamy sputum, and vomiting. Diagnosis: Based on the symptoms and imaging findings, the patient was diagnosed as REPE. Interventions: After the condition of the patient deteriorated rapidly, he was transferred to intensive care unit and then mechanical ventilation and conservative treatment were performed after endotracheal intubation. Outcomes: After mechanical ventilation and conservative treatment in the intensive care unit, the symptoms and radiological findings improved, and then mechanical ventilation was weaned and the chest tube was removed from the patient. However, due to recurrent pneumothorax after removal of the chest tube, video assisted thoracoscopic surgery (VATS) wedge resection was performed. At 6 months post-operative follow up, he was well with normal radiological findings. Lessons: REPE occurs rarely, but once it does, it causes a serious condition that can be life-threatening. Therefore, patients with the risk factors related to it should receive a closed observation after chest tube insertion. Moreover, if REPE occurs, appropriate treatments should be carried out by recognizing it early.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe re-expansion pulmonary edema after chest tube insertion for the treatment of spontaneous pneumothorax

Song¹

2021

Medicine

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“…Some evidence suggests that the use of diuretics, steroids, and inotropes may be considered based on clinical indications. 29 , 30 , 31 The use of ibuprofen or prostaglandin analogs such as misoprostol for the cytoprotective or anti-inflammatory effects has been reported, but the benefit is still unclear. 32 Suction should not be routinely given to patients who have these risk factors due to the increased risk of RPE.…”

Section: Discussionmentioning

confidence: 99%

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

Willim,

Munthe,

Vanto

et al. 2024

J Cardiovasc Thorac Res

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Re-expansion pulmonary edema (RPE) is a rare but potentially life-threatening complication that can occur after rapid lung expansion following the management of lung collapse. This meta-analysis aimed to investigate the risk factors for RPE following chest tube drainage in patients with spontaneous pneumothorax. We conducted a comprehensive systematic literature search in electronic databases of PubMed, ScienceDirect, Cochrane Library, and ProQuest to identify studies that explore the risk factors for RPE following chest tube drainage in spontaneous pneumothorax. Pooled odds ratios (OR) or weighted mean differences (WMD) were calculated to evaluate the risk factors. Statistical analysis was conducted using Review Manager 5.3 software. Five studies involving 1.093 spontaneous pneumothorax patients were included in this meta-analysis. The pooled analysis showed that the following risk factors were significantly associated with increased risk of RPE following chest tube drainage: the presence smoking history (OR=1.94, 95% CI: 1.22-3.10, P=0.005, I2=0%), longer duration of symptoms (WMD=3.76, 95% CI: 2.07-5.45, P<0.0001, I2=30%) , and larger size of pneumothorax (WMD=16.76, 95% CI: 8.88-24.64, P<0.0001, I2=78%). Age, sex, and location of pneumothorax had no significant association. In patients with spontaneous pneumothorax, the presence of smoking history, longer duration of symptoms, and larger size of pneumothorax increase the risk of development of RPE following chest tube drainage.

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“…1 Therefore, physicians should consider the possibility of RPE following pleural drainage. Most reported cases involve ipsilateral RPE [2][3][4] ; however, the pathophysiologic mechanism of contralateral RPE remains unclear. We report a case of contralateral RPE after pleural drainage and compare its progression to that of previously reported cases to better understand the pathophysiology of this complication.…”

Section: Introductionmentioning

confidence: 99%

Acute contralateral reexpansion pulmonary edema within a few hours of pleural drainage

et al. 2022

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We report a case of an 83-year-old male patient with massive tuberculous pleural effusion. Percutaneous drainage was performed following a diagnosis of tuberculous pleurisy. Fifteen minutes into the procedure, the patient's condition deteriorated suddenly, necessitating mechanical ventilatory support. A chest radiograph performed after intubation showed partial collapse of the affected lung with pneumothorax. Despite sufficient air drainage and lung expansion, the patient's oxygen demand remained high. A repeat chest radiograph performed 30 minutes after chest tube insertion revealed partial expansion of the affected lung and severe infiltrative patterns in the unaffected lung, suggesting contralateral reexpansion pulmonary edema.

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Re-expansion pulmonary oedema after spontaneous pneumothorax treatment with chest tube placement

Cited by 4 publications

References 6 publications

Severe re-expansion pulmonary edema after chest tube insertion for the treatment of spontaneous pneumothorax

Severe re-expansion pulmonary edema after chest tube insertion for the treatment of spontaneous pneumothorax

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

Acute contralateral reexpansion pulmonary edema within a few hours of pleural drainage

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