New classification and clinical characteristics of reexpansion pulmonary edema after treatment of spontaneous pneumothorax

• Published in: The American journal of emergency medicine Vol. 27; no. 8; pp. 961 - 967
• Main Authors: Kim, Yun Kwon, MD, Kim, Hyun, MD, Lee, Christopher C., MD, Choi, Han Joo, MD, Lee, Kang Hyun, MD, Hwang, Sung Oh, MD, Oh, Joong Hwan, MD, Lee, Young Han, MD, Singer, Adam J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2009; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Chi-Square Distribution; Classification; Computed tomography; Confidence intervals; Edema; Emergency; Emergency medical care; Female; Humans; Hypoxia; Intensive care medicine; Male; Medical sciences; Middle Aged; Mortality; Pneumology; Pneumothorax - surgery; Postoperative Complications - classification; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Prospective Studies; Pulmonary Edema - classification; Pulmonary Edema - diagnostic imaging; Pulmonary Edema - epidemiology; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Radiography; Risk Factors; Statistics, Nonparametric; Thoracostomy; Tomography, X-Ray Computed; Tuberculosis; South Korea; Pneumothorax; Intensive care; Treatment; Effusion; Respiratory disease; Classification; Pleural disease; Lung edema; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2008.07.036

Abstract Objective Reexpansion pulmonary edema (REPE) is a rare yet sometimes fatal complication associated with the treatment of lung diseases such as pleural effusion, pneumothorax, and hemothorax. The current study summarizes our experience with REPE for a 3-year period. Methods We prospectively collected demographic and clinical data on consecutive patients presenting to an academic university-based emergency department with spontaneous pneumothorax that was treated with closed thoracostomy for a 3-year period. Results Eighty-four study patients were enrolled between December 2002 and September 2005. Reexpansion pulmonary edema developed in 25 of 84 (29.8% [95% confidence interval, 21.0-40.2]) patients. Many cases of REPE were small and asymptomatic and only diagnosed on computed tomography of the chest. There was only one death (1.2% [95% confidence interval, A to B]). Reexpansion pulmonary edema was associated with patients with larger pneumothoraces without fibrotic changes and with patients with hypoxia and fibrotic changes. Classic REPE as seen on chest radiograph was 16 (19.0%) in 84 patients. Diffuse REPE as seen only on computed tomography and involved more than 1 lobe was 1 (1.2%) in 84 patients. Isolated REPE as seen only on computed tomography and limited to lesser than 1 lobe was 8 (9.5%) in 84 patients. Conclusions The rate of REPE after tube thoracostomy of spontaneous pneumothorax is greater than previously reported and often asymptomatic. The risk of developing REPE is greater with larger pneumothorax, especially in patients without fibrotic lung changes, and with hypoxia in patients with fibrotic changes.