A Study of Incidence Rate of A Reexpansion Pulmonary Edema (RPE) and Its Approaching

Reexpansion Pulmonary Edema (RPE) is a complication of the treatment of lung collapse secondary to Pneumothorax, Pleural Effusion, Chylothorax or Atelectasis and can be potentially deathful. Recent studies about its pathogenesis are based on altering pulmonary vascular permeability secondary to hypoxic injury during collapse of the lung. Shift from cellular metabolism to anaerobic metabolism releases the mediators which cause alveolar epithelial and endothelial damages.

This study was carried out to examine incidence rate of a Reexpansion Pulmonary Edema (RPE) and its approaching.

In our study, we selected all inpatients with Pneumothorax (200 cases), Pleural Effusion (100 cases), Chylothorax (9 cases) and Atelectasis (80 cases) in Razi Hospital of Rasht (surgery department) from January, 1994 till March, 1999. Chest tube was placed in patients with Pneumothorax, Pleural Effusion and Chylothorax and in patients with Atelectasis, management for elimination of intrabronchial obstruction was done.

We found 20 cases of RPE (%5.1) in a total of 389 patients. In these 20 cases, 16 cases (%80) were symptomatic within first hour and 4 cases (%20) were symptomatic within 24 hours of reexpansion. Severe tachypnea was seen in 15 cases (%75) and mild tachypnea in 5 cases (%25). Frothy or blood- tinged sputum was observed in 15 cases (%75). Wet rales and anxiety in all of the patients were evident. There was Freely perspiring in 14 cases (%70). One of the patients with pneumothorax died. Treatments in these 20 cases were as follows: oxygen in all of the patients (%100), steroids in 14 cases (%70), suppository of Indomethacin in 11 cases (%55), disconnection of the chest tube in 9 cases (%45), Digoxin in 7 cases (%35), lasix in 6 cases (%30), bronchodilator in one case (%5) and ventilator support in 5 cases (%25).

Incidence of RPE is considerable, so its recognition very importance. Clinical manifestations are always those that we expect in pulmonary edema. Although mortality in our study was %5 but the reported figure in previous studies was as high as %20 after reexpansion that is a cosiderable percentage.