Severe Reexpansion Pulmonary Edema

Abstract

Reexpansion pulmonary edema (RPE) occurs in up to 1% of cases of thoracentesis or pleural drainage. Reported mortality ranges from 16 to 20%. The pathophysiology of RPE is not yet well understood, but it involves factors such as a decrease in pulmonary surfactant and inflammatory mediators. Prevention measures are the best strategy in managing patients with massive pleural effusions (> 1500 ml) and chronic pneumothoraces (> 72 hours) that can lead to RPE. These consist of slow drainage so that lung expansion is not abrupt, the pre-drainage administration of intravenous corticosteroids and the use of non-invasive positive airway pressure (CPAP or BiPAP).