Reexpansion pulmonary edema

Stawicki, S. Peter; Sarani, Babak and Braslow, Benjamin M. (2008) Reexpansion pulmonary edema. OPUS 12 Scientist, 2 (2). pp. 29-31. ISSN 1940-8633

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Abstract

Key points: (a) Reexpansion pulmonary edema - RxPE – is a rare form of acute lung injury, with an incidence of approximately 1% following evacuation of a pneumothorax; (b) RxPE usually follows rapid reinflation of collapsed lung parenchyma; (c) The most common factor associated with RxPE is the duration of lung collapse – more than 3 days seems to be the critical amount of time; (d) The pathophysiologic changes associated with RxPE are complex and not yet fully understood; (e) The pathologic process results from a combination of rapid pulmonary reexpansion with concurrent mechanical alveolar injury, decrease in surfactant and regional lung tissue hypoxemia, inflammatory cell migration and release of inflammatory mediators, and the resulting changes in capillary-alveolar barrier occurring concurrently with increased capillary/hydrostatic pressures; (f) Clinical manifestations of RxPE vary from minimal symptoms to life-threatening hypoxia and cardio-respiratory collapse; (g) The patient may experience dyspnea, thoracic pain, cough with or without pink/foamy sputum, cyanosis, rales and stertors on auscultation. Other clinical symptoms may include fever, nausea, vomiting, tachycardia, and hypotension; (h) The symptoms of RxPE usually appear within the first two hours following pulmonary reexpansion, but may be delayed by as many as 24 to 48 hours; (i) RxPE usually lasts clinically for as long as 1 to 2 days, but may take anywhere from 5 to 7 days to resolve; (j) Critical care practitioners should be familiar with the most common factors involved in the pathogenesis of RxPE; (k) The knowledge of these predisposing factors and the ability to effectively treat RxPE are important to prevention and treatment of this potentially fatal condition. ICU CORNER is a section of OPUS 12 Scientist dedicated to brief topic reviews geared toward preparation for various Critical Care Board Examinations. Each quarterly edition of OPUS 12 Scientist will contain one or two condensed overviews, each accompanied by a list of selected references. Contributions via regular article submission process are welcome, subject to Editorial Board and Section Editor approval. Citation: Stawicki SP, Sarani B, Braslow BM. Reexpansion pulmonary edema. OPUS 12 Scientist 2008;2(2):29-31. Keywords: Reexpansion pulmonary edema, Acute lung injury, Risk factors, Lung reinflation, Diagnosis and treatment, Morbidity and mortality.

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