Is severe re-expansion pulmonary edema still a lethal complication of closed thoracostomy or thoracic surgery?

Re-expansion pulmonary edema (REPE) is a lethal complication that can occur after inserting a chest tube. However, no clinical research reports have analyzed the progress and treatment of REPE, except for a single case report review. We retrospectively analyzed the common clinical characteristics, clinical progress, and treatment outcome of REPE with respiratory failure.

We retrospectively reviewed the clinical features, treatment, and outcomes of eight patients with REPE who required ventilator care from March 2004 to March 2018.

The mean PaO₂/FiO₂ ratio of the patients immediately after intubation was 106.5±20.2 (range, 75-128), which indicated severe hypoxia in all cases. On the first day of treatment, most of the patients showed improvement in hypoxia symptoms, and most improved to the extubation level on day 3. The mean duration of ventilator use was 2.5±0.8 days (range, 1-4 days), and the mean duration of inotropic drug use was 1.1±0.7 days (range, 0-2 days). The mean intensive care unit (ICU) stay was 4.4±1.5 days (range, 3-8 days). No deaths were recorded during the study period, and no cases of permanent complications due to REPE were observed.

REPE requiring ventilator care is a lethal disease. However, continued development of ICU care has dramatically decreased mortality. Low positive end-expiratory pressure (PEEP), low tidal and high O₂ ventilator care represents the most appropriate treatment for REPE.