Reexpansion Pulmonary Edema

Mahfood, Saade; Hix, W. R.; Aaron, Benjamin; Blaes, Peter; Watson, Donald C.

doi:10.1016/s0003-4975(10)62480-0

Cited by 334 publications

(249 citation statements)

References 33 publications

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“…9 Reexpansion pulmonary edema occurs within the first hour or subsequent 24 hours in 64% of patients. 1,10 In the present case, RPE occurred 6 hours postoperatively and improved within 72 hours. The right lung, of which a substantial portion was collapsed, was affected as was the contralateral lung, albeit less extensively.…”

Section: Discussionsupporting

confidence: 51%

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Untitled

Kara

Şen²,

Akçay³

et al. 2018

Exp Clin Transplant

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Hydrothorax occurs frequently in patients with endstage liver disease and usually requires drainage of pulmonary effusion during the hepatectomy phase of liver transplant. Reexpansion pulmonary edema is a rare but potentially fatal complication seen after rapid reexpansion of the collapsed lung following thoracentesis of pleural fluid or tube drainage of pneumothorax. This condition, which manifests with various degrees of clinical severity, is rarely reported following liver transplantation. Herein, we present a 62-year-old male patient who developed reexpansion pulmonary edema after drainage of massive pleural effusion, which caused a total collapse in the right hemithorax during liver transplant. Six hours after pleural fluid drainage, the patient developed a nonproductive cough, mild tachypnea, shortness of breath, and low oxygen saturation (88%). His chest radiograph showed diffuse heterogeneous opacities in the right hemithorax. Computed tomography of the thorax revealed consolidations containing air bronchograms and ground glass opacities in the parenchyma of the right lung; these findings did not extend to the periphery and were observed less frequently in the inferoposterior left lung. These symptoms and radiologic findings were diagnosed as reexpansion pulmonary edema. Complete clinical and radiologic improvements were achieved within 72 hours of mechanical ventilatory support.

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Section: Discussionsupporting

confidence: 51%

“…1 Its incidence ranges from 1% to 14%. 2,3 Hepatic hydrothorax is a complication of cirrhosis, and the fluid is usually drained before liver transplant or during the procedure.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Kara

Şen²,

Akçay³

et al. 2018

Exp Clin Transplant

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“…REPE is usually treated with artificial ventilation using oxygen therapy or PEEP, corticosteroids, and diuretics. 5 In our patient, respiratory management using synchronized intermittent mandatory ventilation and PEEP was beneficial in decreasing airway secretions within a relatively short period of time. Although no consensus exists regarding the optimal level of PEEP for patients with REPE, we were able to treat our patient with 10 cm H 2 O, a standard level of PEEP.…”

Section: To the Editormentioning

confidence: 65%

Re-expansion pulmonary edema following treatment of spontaneous pneumothorax during oral surgery

Momota

Yasutome

Kotani

et al. 2009

Can J Anesth/J Can Anesth

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Re-expansion pulmonary edema (REPE) often develops as edema with increased permeability and warning signs including dyspnea, cough, bloody foam-like sputum developing within 2 hr after rapid re-inflation of the lung, and subacute (C3 days) or chronic collapse. 1,2 A 58-yr-old male with mandibular gingival cancer and a history of transient pleuritic pain three days prior to surgical resection of the cancer underwent general anesthesia. Preoperative spirography revealed restrictive impairment, and a plain chest x-ray revealed no evidence of bullae, although clear lung markings were not visible at the apex of the right lung. After nasotracheal intubation, breath sounds decreased in the patient's right lower lung and insufficient movement of his right chest was observed. During surgery, the patient's lungs were ventilated using intermittent positive pressure ventilation (IPPV). Lung collapse occurred after surgery had been in progress for about 4.5 hr. A chest x-ray revealed collapse of all portions of the right lung and left mediastinal shift (Fig. 1). The lung collapse was treated with tube drainage to evacuate 1000 mL of air over 15 min. Immediately after drainage was initiated, frothy secretions were observed in the endotracheal tube. Chest x-ray examination at that time revealed diffuse infiltration of the right lung, and pulmonary edema developed immediately after re-expansion of the collapsed alveoli (Fig. 1). The patient was treated with dexamethasone, albumin, diuretics, and frequent suction, but he continued to exhibit hypoxemia and dyspnea. Positive end-expiratory pressure ventilation (PEEP) and aggressive tracheal suctioning were initiated, and the patient's condition improved over a 60-hr period.A follow-up interview with our patient after recovery revealed that he had experienced sudden back pain when descending stairs three days before surgery, but he ignored the warning signs because the pain disappeared within a few minutes. It is very likely that a small spontaneous pneumothorax developed at that time. If chest x-ray examination had been performed when the abnormal respiratory sounds occurred, pneumothorax may have been detected earlier and development of REPE may have been prevented. The mechanisms of developing REPE are believed to include a direct consequence of low alveolar oxygen concentration associated with long-lasting lung collapse and an increase in the permeability of pulmonary blood vessels by vasoactive substances due to an acute increase in blood flow in pulmonary capillary vessels. 3 In the present case, lungs with long-term collapse were treated with controlled positivepressure ventilation (F I O 2 = 43%). Although PaO 2 was maintained at C100 mmHg during surgery, permeability of lung vessels was increased after re-inflation. Abrupt increase in blood flow in pulmonary capillaries rather than hypoxemia in the alveoli was considered a principal cause of the development of REPE. Due to spontaneous pneumothorax, slow re-inflation using a Heimlich valve or water seal device is recommende...

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“…It mostly affects patients with cardiac failure who are in a dependent position 28 . Pulmonary edema due to scorpion envenomation is well known but its unilateral occurrence is rare 3,14,15,22 .…”

Section: Discussionmentioning

confidence: 99%

Asymmetric pulmonary edema after scorpion sting: a case report

Razi

Malekanrad

2008

Rev. Inst. Med. trop. S. Paulo

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SUMMaRYA 12-year-old boy was referred with acute asymmetric pulmonary edema (APE) four-hour after scorpion sting to Emergency department. On admission, the main clinical manifestations were: dyspnea, tachypnea, and tachycardia. Chest x-ray revealed APE predominantly on the right hemithorax. The patient was treated with oxygen, intravenous frusemide and digoxin and discharged on the sixth hospital day in a good condition. This case report emphasizes the occurrence of asymmetric pulmonary edema after severe scorpion envenomation within few hours immediately after the sting.

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Reexpansion Pulmonary Edema

Cited by 334 publications

References 33 publications

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Re-expansion pulmonary edema following treatment of spontaneous pneumothorax during oral surgery

Asymmetric pulmonary edema after scorpion sting: a case report

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