Perioperative reexpansion pulmonary edema

ABSTRACT

Reexpansion pulmonary edema is a rare form of acute lung injury following rapid re inflation of collapsed lung parenchyma. It can rarely be associated with anaesthesia and repair of traumatic diaphragmatic hernia.We report a case of reexpansion pulmonary edema [REPE] occurring during repak of traumatic diaphragmatic hernia in an adult male. He was a victim of occupational trauma and presented to casualty with complaints of dyspnoea and left sided chest discomfort soon after the injury. Oxygen supplementation was administered via simple face mask to compensate for his hypoxemia. Chest radiograph revealed left diaphragmatic hernia and he was taken up for surgery. Under general anaesthesia with two lung ventilation and epidural analgesia via a thoraco-abdominal approach reduction of abdominal contents with diaphragmatic repair was undertaken. Intraoperatively within an hour of lung expansion he developed pulmonary edema. In spite of altered ventilation perfiision dynamics in the lateral decubitus position he was successfully treated on table. He recovered after a couple of days of invasive ventilatory support. Prompt diagnosis and treatment can reduce the lethality of this condition