Re-expansion pulmonary oedema: is its prevention possible?

lungs are re-expanded rapidly, it is seen with short duration collapse and re-expansion without suction (in 15 of 47 cases available for assessment). Most cases were following pneu-mothoraces; 7 following effusion drainage. The volumes were between 1000 ml and 4500 ml. Laws et al. w13x and Antunes et al. w14x documented the BTS's advice on the evacuation of pneumothoraces and pleural effusions. The former says 'good practice suggests that no more than about 1.5 l should be drained at one time«' There is certainly evidence at thoracoscopy that much larger volumes of fluid can be safely drained. The latter paper notes that, 'caution should be taken if removing)1.5 l on a single occasion'. There are cases of REPO occurring with-1.5 l, which may be related to the negative intrapleural pressure, the amount of time that the lung has been down and the age of the patients. Caution – for example in avoiding high intrapleural pressures – should be applied irrespective of the amount of fluid drained, with vigilance to the development of any respiratory symptoms. If no symptoms occur, then there is little good evidence to prohibit draining an effusion to dryness. 7. Clinical bottom line REPO does occur following re-expansion of a lung in pneumothorax and pleural effusion. The incidence of REPO following pneumothorax and effusion is between 0 and 1% in most studies. The BTS guidelines suggest-1.5 l pleural fluid should be drained at one time. Provided no respiratory symptoms occur it is not unreasonable to drain larger volumes to dryness: caution should be taken to avoid high negative intrapleural pressures. Patients who appear to be at higher risk, which may warrant more gradual evacuation, are: those who have had large pneumothoraces; young patients; patients in whom the lung has been down)7 days; and possibly those who have)3 l of pleural fluid drained. Congratulations to the authors for raising and clearing a lot of air surrounding re-expansion pulmonary oedema (REPE) w1x. Re-expansion pulmonary oedema is a distinct entity as is proved in this article. Its incidence is definitely much more common than hitherto believed. If looked for specifically, a subtle change in luscency of radiographs can frequently be picked up in post-drainage skiagram. In my experience, the longer the duration of pneumothorax or effusion, the greater the chances of REPE. Age of the patient or pre-existing lung pathology have not been found to have linear correlation with REPE. …