Alkouh Rajae, Essaad Ounci, Yazough Issam, Labib Smael
Department of Intensive Care Unit, Mohammed VI University Hospital, Tanger, Morocco.
Unit of Critical Emergency Care, Mohammed VI University Hospital, Tanger, Morocco.
Ann Med Surg (Lond). 2025 Feb 28;87(4):2382-2384. doi: 10.1097/MS9.0000000000003037. eCollection 2025 Apr.
Re-expansion pulmonary edema (REPE) is a rare but potentially fatal complication that occurs after rapid re-expansion of a collapsed lung, particularly following pleural drainage. The exact pathophysiology remains poorly understood, but several interrelated mechanisms are involved, such as fluid overload and alteration of the alveolar-capillary barrier. The mortality rate varies between 5% and 20% according to the literature. Early recognition and effective treatment of this complication is essential to reduce the associated morbidity and mortality.
A 22-year-old patient suffered a fall from the third floor. Imaging revealed several fractures, a subgaleal hematoma and a right pneumothorax. After surgery to stabilize the fractures, a worsening of the pneumothorax necessitated pleural drainage without aspiration. One hour after drainage, the patient developed respiratory distress and an X-ray showed unilateral pulmonary edema. Treatment with continuous positive airway pressure was initiated, resulting in rapid improvement and disappearance of radiological signs. The chest tube was removed and the patient was transferred to the trauma unit.
REPE usually occurs after rapid re-expansion of the lung. The main risk factors include young age, prolonged lung collapse and excessive drainage. Treatment is preventive (slow drainage, without aspiration) and symptomatic (oxygen therapy, assisted ventilation if necessary).
REPE is a little-known but potentially fatal complication of thoracic drainage. It is essential to understand the risk factors and adopt appropriate preventive measures. Early identification and prompt management are crucial to avoid a severe course. Despite advances in our understanding of EPR, further research is needed to better elucidate its mechanisms and optimize its management.
复张性肺水肿（REPE）是一种罕见但可能致命的并发症，发生于萎陷肺快速复张后，尤其是在胸腔引流后。其确切病理生理学仍了解甚少，但涉及多种相互关联的机制，如液体超负荷和肺泡 - 毛细血管屏障改变。根据文献，死亡率在5%至20%之间。早期识别和有效治疗该并发症对于降低相关的发病率和死亡率至关重要。
一名22岁患者从三楼坠落。影像学检查显示多处骨折、帽状腱膜下血肿和右侧气胸。在进行骨折固定手术后，气胸恶化，需要进行胸腔引流且不抽气。引流1小时后，患者出现呼吸窘迫，X线显示单侧肺水肿。开始采用持续气道正压通气治疗，结果放射学征象迅速改善并消失。拔除胸腔引流管，患者被转至创伤科。
REPE通常发生在肺快速复张后。主要危险因素包括年轻、肺萎陷时间延长和引流过多。治疗方法包括预防性（缓慢引流，不抽气）和对症性（氧疗，必要时辅助通气）。
REPE是一种鲜为人知但可能致命的胸腔引流并发症。了解危险因素并采取适当的预防措施至关重要。早期识别和及时处理对于避免病情严重发展至关重要。尽管我们对REPE的认识有所进步，但仍需要进一步研究以更好地阐明其机制并优化治疗管理。
