Reexpansion Pulmonary Edema

REINFLATION OF A collapsed lung in some cases may lead to pulmonary edema of the reexpanded lung. This iatrogenic complication, termed “reexpansion pulmonary edema” (RPE), may occur after the treatment of a lung that has collapsed because of a pneumothorax or pleural effusion. The first known case of RPE occurred in 1853, when 3 L of pleural fluid were drained by Pinault. 1 Pinault H. Considérations cliniques sur la thoracentèse. 1853 Google Scholar The first well-described case was by Foucart in 1875. 2 Foucart E.J. De la Morte Subite ou Rapide Apres la Thoracentese. 1875 Google Scholar These early cases all followed drainage of large amounts of pleural fluid. At the turn of the century, it had been recommended to treat pleural effusions with thoracentesis, using high amounts of suction. 3 Riesman D. Albuminous expectoration following thoracentesis. Am J Med Sci. 1902; 123: 620-630 Google Scholar The first report of a patient who developed RPE after treatment for a totally collapsed lung because of pneumothorax was by Carlson 4 Carlson R.I. Classen K.L. Gollan F. et al. Pulmonary edema following the rapid expansion of a totally collapsed lung due to pneumothorax: A clinical and experimental study. Surg Forum. 1958; 9: 367-371 PubMed Google Scholar in 1958. Reexpansion pulmonary edema may occur in the perioperative setting, which may complicate an anesthetic. 5 Desiderio D.P. Meister M. Bedford R.F. Intraoperative re-expansion pulmonary edema. Anesthesiology. 1987; 67: 821-823 Crossref PubMed Scopus (8) Google Scholar In that case, more than 3 L of pleural fluid were removed intraoperatively during a thoracotomy. The lung, which had been chronically collapsed because of a malignant pleural effusion, was reexpanded intraoperatively after a subtotal pleurectomy. The pulmonary edema occurred within 1 hour of lung reexpansion but cleared over the next 2 to 3 hours with positive-pressure ventilation. The purpose of this review is to discuss the incidence, clinical features, pathophysiology, and management of the pulmonary edema that may occur after reexpansion of a collapsed lung.