Predictive Factors of Re-expansion Pulmonary Edema of Patients with Large Spontaneous Pneumothorax after Chest Tube Insertion

ABSTRACT

PURPOSE: Reexpansion pulmonary edema (REPE) is rare but sometimes fatal complications can follow chest tube insertion for treatment of pneumothorax. The study assessed the medical records of patients who developed large pneumothroax and searched for the predictive factors and prediction equation for REPE. METHODS: The medical records of patients treated at an emergency department for pneumothorax from January 1, 2008 to December 31, 2009 were reviewed retrospectively. We compared the group that developed REPE with the group that did not develop REPE for clinical and demographic factors. Logistic regression analysis was used to identify predictive factors and prediction equation. We used receiver operator characteristic (ROC) curve analysis to identify optimal cut-off value and assessed the validity of the prediction equation. RESULTS: We screened out 92 large pneumothorax patients among 578 pneumothorax patients. Twenty two cases developed REPE. The calculated prediction equation was 28.955+0.147xsymptom duration before chest tube insertion (days)+0.048xsize of pneumothorax(%)-0.359xSaO2 (%). The results of assessment of the prediction equation using ROC curve analysis were Area under the ROC curve=0.834 and sensitivity 90.9% and specificity 70.0% at the cut-off value 0.210. CONCLUSION: In patients with large pneumothorax, time interval between symptom development and chest tube insertion, size of pneumothorax, and oxygen saturation rate of peripheral artery blood were identified as predictive factors. The prediction equation that we developed for REPE showed good predictability.