ABSTRACT
A 54-year-old man with ischemic mitral regurgitation underwent surgical ventricular restoration, mitral valve plasty and a coronary artery bypass. A chest X-ray 7 days later revealed pleural effusion on the right side. A chest tube was inserted and about 1,000 ml of fluid was drained. However, re-expansion pulmonary edema (RPE) occurred 2 h later. Positive pressure ventilation and intravenous infusion with a diuretic improved the RPE. He was resuscitated on the following day to receive percutaneous cardiopulmonary support (PCPS) for unstable hypoxemia and hypotension. Oxygenation improved, PCPS was withdrawn 2 days later, and the endotracheal tube was removed. Re-expansion pulmonard. He was resuscitated on the following day to receive percutaneous cardiopulmonary support (PCPS) for unstable hypoxemia and hypotension. Oxygenation improved, PCPS was withdrawn 2 days later, and the endotracheal tube was removed. Re-expansion pulmonary edema might cause fatal short-term cardio-respiratory failure. We considered that RPE requires appropriate early diagnosis, early treatment and aggressive therapy, including PCPS.
ABSTRACT
Reexpansion pulmonary edema (RPE) is a rare but sometimes fatal complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis. We experienced a case of RPE that developed following decortication. A 46 year-old female had a decortication for pyothorax under one-lung anesthesia. There was no event during the operation and results of arterial blood gas analysis were within normal limits. After the operation, tracheal extubation was performed and 100% oxygen saturation on a pulse oximeter (SpO2) was maintained with 100% O2, (8 L/min) via mask ventilation with self-respiration. The patient, with 50% Venturi mask, was transported to the intensive care unit (ICU). On arrival at the ICU, a SpO2 of 80% was detected and arterial blood gas analysis revealed hypoxemia with acute hypercapnic respiratory acidosis. Fortunately, reexpansion pulmonary edema was detected early and intensive treatment was performed using mechanical ventilation with positive end-expiratory pressure. Tracheal extubation was performed after 1 day of mechanical ventilation. The reexpansion pulmonary edema was successfully treated and the patient recovered without any complications.
Subject(s)
Female , Humans , Acidosis, Respiratory , Airway Extubation , Anesthesia , Hypoxia , Blood Gas Analysis , Empyema, Pleural , Intensive Care Units , Masks , Oxygen , Pleural Effusion , Pneumothorax , Positive-Pressure Respiration , Pulmonary Atelectasis , Pulmonary Edema , Respiration, Artificial , VentilationABSTRACT
Reexpansion pulmonary edema is not a common phenomenon after chest tube insertion but some reports from 0% to 14%. There are various resulting complications, including acute respiratory distress syndrome. We report a case of focal reexpansion pulmonary edema after chest tube insertion. A 49-year-old male came to the hospital due to ongoing dyspnea and left chest pain for 3 days. On chest X-ray, the patient had a left pneumothrax. We planned to insert a chest tube for symptom relief. To determine whether or not the chest had expanded as a result of the chest tube insertion, the patient underwent repeated chest X-rays the following day. The patient experienced brief respiratory symptoms upon initial suction; a chest PA showed patchy consolidated infiltration at the inserted site. After 5 days of conservative management, the recovered completely.
Subject(s)
Humans , Male , Middle Aged , Chest Pain , Chest Tubes , Dyspnea , Pneumothorax , Porphyrins , Pulmonary Edema , Respiratory Distress Syndrome , ThoraxABSTRACT
Cannulation of a large central vein is the standard clinical method for mornitoring CVP and is also performed for a number of additional therapeutic interventions, such as providing secure vascular access for administration of vasoactive drugs or to initiate rapid fluid resuscitation in operation or for aspiration of air emboli. But there are many complications such as vessel injury, pneumothorax, nerve injury, arrhythmias, arteriovenus thrombus, pulmonary emboli, infection at insertion site, because there are major vessels, nerve and organs around of central veins. We report a case of Rt. Hydrothorax after internal jugular vein cannulation and a contralateral reexpansion pulmonary edema and pleural effusion after Rt. chest tube insertion for hydrothorax.
Subject(s)
Arrhythmias, Cardiac , Catheterization , Catheters , Chest Tubes , Hydrothorax , Jugular Veins , Pleural Effusion , Pneumothorax , Pulmonary Edema , Resuscitation , Thorax , Thrombosis , VeinsABSTRACT
A hepatic hydrothorax is a pleural effusion that develops in patients with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. It is a complication of end-stage liver disease, and a liver transplant is the treatment of choice. In our case, a reexpansion pulmonary edema occurred after evacuating 4,250 ml of ascites and aspirating 3,600 ml of the pleural effusion within 15 minutes aimed at visually improving the surgical field in a 46-year-old male patient receiving a liver transplant. 1 hour 30 minutes after aspirating the pleural effusion, the level of oxygen saturation decreased from 100% to 95%, and serosanguinous fluid spilled over from the endotracheal tube. We inserted a double lumen endotracheal tube to both separate and protect the unaffected left lung, and applied CPAP 10 cmH2O at the affected right lung. The reexpansion pulmonary edema was successfully treated using this supportive management.
Subject(s)
Humans , Male , Middle Aged , Ascites , Fibrosis , Hydrothorax , Hypertension, Portal , Liver Diseases , Liver Transplantation , Liver , Lung , Oxygen , Pleural Effusion , Pulmonary EdemaABSTRACT
A 60-year old male patient admitted with complaints of dyspnea and pleuritic chest pain. The chest X-ray demonstrated right pleural effusion. We planed to do the conventional thoracentesis to evaluate the characteristics of pleural effusion and to relieve the symptom of the patient. Focal reexpansion pulmonary edema was seen on the follow-up chest X-ray. After the 5-day conservative management, the patient recovered without any complications.
Subject(s)
Humans , Male , Middle Aged , Chest Pain , Dyspnea , Follow-Up Studies , Pleural Effusion , Pulmonary Edema , ThoraxABSTRACT
The authors report a case of Reexpansion Pulmonary Edema (RPE) seen at Hospital de Pronto Socorro de Porto Alegre 3 hours after drainage of spontaneous pneumothorax. The patient presented a unilateral pneumothorax with one-week duration. After pleural drainage respiratory failure occured being managed at the Intensive Care Unit with non-invasive positive pressure ventilation through facial mask. The patient had favorable outcome and was discharged asymtomatic after 72 hours.
ABSTRACT
Acute bilateral reexpansion pulmonary edema after pleurocentesis is a rare complication. In one case, bilateral reexpansion pulmonary edema after unilateral pleurocentensis in sarcoma was reported. Verious hypotheses regarding the mechanism of reexpansion pulmonary edema include increased capillary permeability due to hypoxic injury, decreased surfactant production, altered pulmonary perfusion and mechanical stretching of the membranes. Ragozzino et al suggested that the mechanism leading to unilateral reexpansion pulmonary edema involves the opposite lung when there is significant contralateral lung compression. Here we report a case of bilateral reexpansion pulmonary edema and acute respiratory distress syndrome after a unilateral pleurocentesis of a large pleural effusion with contralateral lung compression and increased interstitial lung marking underlying chronic liver disease.
Subject(s)
Capillary Permeability , Liver Diseases , Lung , Membranes , Perfusion , Pleural Effusion , Pulmonary Edema , Respiratory Distress Syndrome , SarcomaABSTRACT
We have experienced a reexpansion pulmonary edema(RPE) during general anesthesia. This patient has undertaken the decortication operation due to right sided massive pleural effusion and fibrothorax. Generally reexpansion pulmonary edema is believed to oceur only when a chronically collapsed lung is rapidly reexpanded by evacuation of large amount of air or fluid in pneumothorax and pleural effusion. The pathogenesis of RPE is unknown and is probably multifactorial. The implicated etiologies are chronicity of collapse, technique of reexpansion, increased pulmonary vascular permeability, airway obstruction, loss of surfactant and pulmonaty artery pressure changes. The outcome of RPE may be fatal, so physician treating lung collapse must be aware of the possible causes and endeavor to prevent the occurrence of this complieation.