Reexpansion pulmonary edema

ABSTRACT Key points : (a) Reexpansion pulmonary edema - RxPE – is a rareform of acute lung injury, with an incidence of approximately 1%following evacuation of a pneumothorax; (b) RxPE usuallyfollows rapid reinflation of collapsed lung parenchyma; (c) Themost common factor associated with RxPE is the duration of lungcollapse – more than 3 days seems to be the critical amount oftime; (d) The pathophysiologic changes associated with RxPE arecomplex and not yet fully understood; (e) The pathologic processresults from a combination of rapid pulmonary reexpansion withconcurrent mechanical alveolar injury, decrease in surfactant andregional lung tissue hypoxemia, inflammatory cell migration andrelease of inflammatory mediators, and the resulting changes incapillary-alveolar barrier occurring concurrently with increasedcapillary/hydrostatic pressures; (f) Clinical manifestations ofRxPE vary from minimal symptoms to life-threatening hypoxiaand cardio-respiratory collapse; (g) The patient may experiencedyspnea, thoracic pain, cough with or without pink/foamy sputum,cyanosis, rales and stertors on auscultation. Other clinicalsymptoms may include fever, nausea, vomiting, tachycardia, andhypotension; (h) The symptoms of RxPE usually appear within thefirst two hours following pulmonary reexpansion, but may bedelayed by as many as 24 to 48 hours; (i) RxPE usually lastsclinically for as long as 1 to 2 days, but may take anywhere from 5to 7 days to resolve; (j) Critical care practitioners should befamiliar with the most common factors involved in thepathogenesis of RxPE; (k) The knowledge of these predisposingfactors and the ability to effectively treat RxPE are important toprevention and treatment of this potentially fatal condition.ICU CORNER is a section of OPUS 12 Scientist dedicated to brieftopic reviews geared toward preparation for various CriticalCare Board Examinations. Each quarterly edition of OPUS12Scientist will contain one or two condensed overviews, eachaccompanied by a list of selected references. Contributions viaregular article submission process are welcome, subject toEditorial Board and Section Editor approval.