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Re-expansion pulmonary oedema: is its prevention possible?

Cardiothoracic Surgery Department, University Hospital of Patras, 22500 Rion Patras, Greece

Does re-expansion pulmonary oedema exist?

Re-expansion pulmonary oedema (REPO) constitutes a non rare complication with many not yet elucidating causative factors. As it is reported by your review [1], as well as by other studies [2, 3], data concerning the incidence, predisposing factors and mortality rate are controversial. In fact, the average incidence of this syndrome should be much higher than 1% mentioned in your article.

All of us have often observed the abrupt appearance of gradually increasing dyspnea, during the massive drainage (> 1000 ml) of pleural effusion. However, the dyspnea is eliminated if we interrupt the drainage for 15-20 min. On the contrary, the non-stop drainage might lead to the complete appearance of the syndrome, inceasing its real incidence. We consider as the more possible explanation of this syndrome, the hypothesis of ischemia/reperfusion injury. In case of massive pleural effusion, a notable segment of lung parenchyma is compressed and therefore becomes ischemic. The sudden re-expansion of the parenchyma due to the massive drainage, leads to the reperfusion injury of the collapsed lung which contributes to a massive production of reactive oxygen species (ROS). A ROS activating the <<cascade>> of ischemia/reperfusion injury, severely impair cell membranes and simultaneously incease the permeability of the vessel wall. As a result, macro-molecules extravasate into alveolar space [4, 5]. There is no doubt, that there are also additional factors such as amount of effusion, time of collapse, age of the patient, the oxidative stress etc., contributing to the complete appearance of the syndrome. The acceptance of this hypothesis, led us to the adoption of the following stategy: in every patient with massive pleural effusion, we suggest the administration of 100 mg Nimesulide per os (Mesulid^®, Boehringer – Ingelheim, Germany), 1 h before the drainage. There is not enough evidence to support the protective action of this agent. However, till this time, none of the 35 patients treated with the above medication underwent REPO or REPO-like reaction during the drainage.

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1. Echevarria C, Twomey D, Dunning J, Chanda B. Does re-expansion pulmonary oedema exist? Interact CardioVasc Thorac Surg 2008;7:485–490.[Abstract/Free Full Text]
2. Matsuura Y, Nomimura T, Murakami H, Matsushima T, Kakehashi M, Kajihara H. Clinical analysis of reexpansion pulmonary edema - comment. Chest 1991;100:1562–1566.[CrossRef][Medline]
3. Feller-Kopman D, Berkowitz D, Boiselle P, Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg 2007;84:1656–1661.[Abstract/Free Full Text]
4. Mahfood S, Hix WR, Aaron BL, Blaes P, Watson DC. Reexpansion pulmonary edema. Ann Thorac Surg 1988;45:340–345.[Abstract]
5. Iqbal M, Multz A, Rossoff L, Lackner R. Re-expansion pulmonary edema after VATS successfully treated With continuous positive airway pressure. Ann Thorac Surg 2000;70:669–671.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Google Scholar Articles by Apostolakis, E. Articles by Koniari, I. PubMed Articles by Apostolakis, E. Articles by Koniari, I. Related Collections Related Article