Severe Respiratory and Hemodynamic Failures following Successful Spontaneous Pneumothorax Drainage

Spontaneous pneumothorax is a frequent situation in respiratory medicine, and its treatment is based on conservative treatment or pleural drainage. Reexpansion pulmonary edema (REPE) is often a mild complication following pneumothorax drainage. We report here a severe case of unilateral REPE following spontaneous pneumothorax drainage associated with major pulmonary plasmatic leakage. The clinical presentation was severe and sudden with respiratory and circulatory failures. Initial resuscitation was mostly based on prone and head-down positioning in association to fluid expansion and mechanical ventilation. On the basis of this clinical case report, we strongly suggest to think about severe pulmonary reexpansion edema when respiratory and hemodynamic failures occur few hours after pneumothorax-related efficient pleural tube drainage.

Re-expansion pulmonary edema after large left pleural effusion

Background: Reexpansion pulmonary edema (REPE) is a complication that arises from a precipitous or rapid expansion of a collapsed lung. This rare complication is thought to arise after using an intercostal drainage tube in patients with a tension pneumothorax, those with large pleural effusions, and occasionally when used therapeutically in thoracentesis. There are a multitude of risk factors, and it usually self-limiting, with the mainstay of treatment being supportive with oxygen. It is believed that 20% of cases are fatal. Case report: A 60-year-old male was treated with a 28 French tube for a large left pleural effusion. He developed REPE shortly after and developed severe shortness of breath, for which he required high flow oxygen. He was managed in the Intermediate Care Unit (IMCU) and shortly after was discharged home.