Reexpansion pulmonary edema after VATS successfully treated with continuous positive airway pressure

doi:10.1016/S0003-4975(00)01455-7

The Annals of Thoracic Surgery

Volume 70, Issue 2, August 2000, Pages 669-671

https://doi.org/10.1016/S0003-4975(00)01455-7 Get rights and content

Abstract

Reexpansion pulmonary edema is a well-described complication of treatment for pleural effusion and pneumothorax. It is very rarely described in association with anesthesia and video-assisted thoracoscopic surgery. The etiology is unclear but several mechanisms have been proposed. We report a case of reexpansion pulmonary edema after video-assisted thoracoscopic surgery treated successfully with continuous positive airway pressure.

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Comment

This case demonstrates a rare association of unilateral pulmonary edema with VATS-effected pleurodesis and a unique response to CPAP therapy. There was no clinical evidence of left ventricular dysfunction and response to therapy made pneumonia an unlikely diagnosis.

Reexpansion pulmonary edema can range from a simple radiologic curiosity to life threatening hypoxemia with a mortality rate as high as 20% [2]. Video-assisted thoracoscopic surgery used increasingly in the treatment of recurrent

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Mujer de 36 años que fue sometida a una resección de timoma gigante que ocupaba gran parte del hemitórax izquierdo. Tras la resección del tumor y la insuflación del pulmón izquierdo apareció un edema pulmonar por reexpansión precoz. Se trató con diuréticos, corticoides y se mantuvo la ventilación mecánica. La paciente evolucionó favorablemente. El edema pulmonar por reexpansión es una complicación poco frecuente, pero con una alta mortalidad. Es fundamental conocer los factores implicados en su etiopatogenia. El diagnóstico y tratamiento se deben realizar de forma inmediata.
A 36 year-old woman who was subjected to resection of a giant thymoma that occupied a large area of the left hemithorax. After resection of the tumour and insufflation of the left lung there was pulmonary oedema due to early re-expansion. She was treated with diuretics and corticoids and was kept on mechanical ventilation. The patient progressed favourably. Although pulmonary oedema due to re-expansion is an uncommon complication it has a high mortality. It is essential to be aware of the factors involved in its aetiopathogenesis. It should be diagnosed and treated immediately.
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Delayed onset of contralateral pulmonary edema following reexpansion pulmonary edema of a collapsed lung after video-assisted thoracoscopic surgery
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This case report describes a 61-year-old man who developed reexpansion pulmonary edema (RPE) of the collapsed left lung after video-assisted thoracoscopic surgery because of left thoracic empyema, complicated with secondary contralateral pulmonary edema later. The left lung was gently reexpanded after surgery under one-lung ventilation anesthesia for 2.5 hours. The patient developed RPE of the left lung immediately after surgery, and required mechanical ventilation with positive end-expiratory pressure support. RPE was resolved within 24 hours. Nevertheless, delayed onset of contralateral pulmonary edema manifested on chest radiography 4 days later without clinical symptoms such as tachypnea or dyspnea. There was no evidence of pulmonary infection, fluid overload, postoperative renal insufficiency or cardiogenic onslaught. Late manifestation of contralateral pulmonary edema in the wake of previous left-sided RPE was suspected from exclusion of possible culprits. Response to steroid therapy made inflammation-related pulmonary edema a likely diagnosis. This case demonstrates that delayed contralateral pulmonary edema with only radiographic evidence can emerge 4 days after resolution of RPE of a collapsed lung. Methods to prevent RPE and management of one-lung ventilation are described.
Thoracoscopic Bleb Resection Using Two-Lung Ventilation Anesthesia With Low Tidal Volume for Primary Spontaneous Pneumothorax
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We performed thoracoscopic surgery for pneumothorax using two-lung ventilation with low tidal volume and evaluated the feasibility and safety of this procedure.
Forty-six patients (mean age, 23.6 ± 10.47 years) each with a primary spontaneous pneumothorax underwent wedge resection with chemical and mechanical pleurodesis. Two-lung ventilation anesthesia was performed with a single-lumen endotracheal tube, and the tidal volume was reduced to 4 mL/kg; the respiratory rate was increased to 24 cycles/min. Airway pressure, end-tidal CO₂, and the results of blood gas analysis were obtained right after endotracheal intubation and during the operation, and were compared.
The tidal volume was 496.2 ± 94.33 mL at anesthesia induction, which decreased to 243.9 ± 34.43 mL during the two-lung ventilation. In 5 patients, the tidal volume was additionally decreased by 32.5 ± 12.58 mL (p = 0.014) to obtain an optimal working field. The differences between the airway pressure, pH, partial pressure of carbon dioxide, and partial pressure of oxygen were significant between the two measurement times. However, all of the values of the arterial blood gas analysis were within normal range. The oxygen saturation (99.9% ± 0.69% versus 99.8 ± 0.72%; p = 0.160) and end-tidal CO₂ (33.2 ± 3.74 mm Hg versus 34.1 ± 4.19 mm Hg; p = 0.157) were not significantly different. The time from intubation before the incision was 17.1 ± 4.18 minutes, the operation time was 31.9 ± 14.48 minutes, and the total anesthesia time was 65.8 ± 15.02 minutes.
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Case reportReexpansion pulmonary edema after VATS successfully treated with continuous positive airway pressure

Abstract

Section snippets

Comment

Chest

Ann Thorac Surg

Ann Thorac Surg

Am J Med

Case report
Reexpansion pulmonary edema after VATS successfully treated with continuous positive airway pressure