During pleural drainage use of water stamp minimizes the risk of reexpansion pulmonary edema mainly if the pulmonary collapse is longer than three days. Reexpansion pulmonary edema permeability pulmonary edema chronic lung collapse pulmonary microvascular injury oxygen-derived free radical When a lung that has collapsed for more than several days is rapidly reexpanded pulmonary edema some-times occurs in the reexpanded lung.
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1310 Apply more positive end-expiratory pressure PEEP and decrease tidal volumes to prevent further alveolar injury and transudation.
How to treat reexpansion pulmonary edema. SirReexpansion pulmonary edema REPE is an uncommon problem that afflicts the reexpanded lung after evacuation of a large pneumothorax or pleural effusionThere are many accounts of REPE occurring in adults but to my knowledge this problem has not been reported in the pediatric population. Reexpansion pulmonary edema after VATS successfully treated with continuous positive airway pressure. The onset of pulmonary edema can be delayed by up to 24 hours in some cases.
Epub 2007 Apr 16. It occurs following 1 of pneumothorax re-expansions or thoracentesis procedures. Computed tomography showed broad ground-glass opacities and poor expansion in the left lung suggestive of reexpansion pulmonary edema RPE Figure 1B.
Although RPE generally is believed to occur only when a chronically collapsed lung is rapidly reexpanded by evacuation of large amounts o. A boy is described in whom severe unilateral pulmonary edema occurred after. The disease is usually self-limited.
Cho SR Lee JS Kim MS. However reasonably good effects can be expected from a symptomatic therapy that reduces the level of mechanical stress during reexpansion. Unilateral reexpansion pulmonary edema RPE is a rare complication of the treatment of lung collapse secondary to pneumothorax pleural effusion or atelectasis.
Steven M Neustein 1. Methylprednisolone pulse therapy 1000 mgday for 3 days was administered. This is called re-expansion pulmonary edema RPE.
1Department of Anesthesiology The Mount Sinai Medical Center New York NY 10029-6574 USA. In the future it is expected that the cause of histological changes of the pulmonary microvessels in a chronically collapsed lung will be revealed and appropriate therapies will therefore be developed according to this cause. Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural cavity performed by either thoracentesis or chest drainage.
Position the patient in the lateral decubitus position with the affected side up to reduce intrapulmonary shunting secondary to edema. Ann Thorac Surg 2000. Your healthcare team may prop you.
Oxygen is always the first line of treatment for this condition. Despite being infrequent mortality may occur in up to 20 of cases and is attributed to the abrupt reduction in pleural pressure especially as a result of extensive pneumothorax drainage or when there is longterm pulmonary collapse. Pulmonary edema is a serious condition that requires quick treatment.
New treatment method for reexpansion pulmonary edema. The negative pressure in pleural drainage used in some situations should be employed only after 24 to 48 h of the drainage thus avoiding the risk of RPE. The exact underlying mechanism is unknown but is thought to be a form of permeability edema related to endothelial changes occurring when the lung has been collapsed for 3 or more days.
669 71. RPE is a rare but potencially lethal complication to consider after rapid re-expansion of large pneumothorax drainage. Treatment is supportive mainly consisting of supplemental oxygen and if necessary mechanical ventilation.
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