Risk Of Reexpansion Pulmonary Edema Research Articles

Unilateral Re-expansions Pulmonary Edema after Thoracic Drainage Insertion in Patient with Extensive Para-pneumonic Pleural Effusion

In presence of extensive pleural effusion, there is usually a largely atelectatic lung. After thoracic drainage insertion and immediate expansion of the lung, there is a risk of re-expansion pulmonary edema. The following case, described as a rare, life-threatening complication, describes the development of a pulmonary edema after insertion of a chest tube in a completely atelectatic lung as a result of compression due to large pleural effusion.

Safe and Effective Bedside Thoracentesis: A Review of the Evidence for Practicing Clinicians.

Physicians often care for patients with pleural effusion, a condition that requires thoracentesis for evaluation and treatment. We aim to identify the most recent advances related to safe and effective performance of thoracentesis. We performed a narrative review with a systematic search of the literature. Two authors independently reviewed search results and selected studies based on relevance to thoracentesis; disagreements were resolved by consensus. Articles were categorized as those related to the pre-, intra- and postprocedural aspects of thoracentesis. Sixty relevant studies were identified and included. Pre-procedural topics included methods for physician training and maintenance of skills, such as simulation with direct observation. Additionally, pre-procedural topics included the finding that moderate coagulopathies (international normalized ratio less than 3 or a platelet count greater than 25,000/μL) and mechanical ventilation did not increase risk of postprocedural complications. Intraprocedurally, ultrasound use was associated with lower risk of pneumothorax, while pleural manometry can identify a nonexpanding lung and may help reduce risk of re-expansion pulmonary edema. Postprocedurally, studies indicate that routine chest X-ray is unwarranted, because bedside ultrasound can identify pneumothorax. While the performance of thoracentesis is not without risk, clinicians can incorporate recent advances into practice to mitigate patient harm and improve effectiveness. Journal of Hospital Medicine 2017;12:266-276.

The facts are the facts

No matter how much you know, you never know all the facts. Juggling facts pervades all parts of medicine. In particular, we seem to love the little contraindications. “You can’t take more than 2 litres off in a thoracentesis before you run the risk of re-expansion pulmonary edema.” “Are

Large-Volume Thoracentesis and the Risk of Reexpansion Pulmonary Edema

To avoid reexpansion pulmonary edema (RPE), thoracenteses are often limited to draining no more than 1 L. There are, however, significant clinical benefits to removing more than 1 L of fluid. The purpose of this study was to define the incidence of RPE among patients undergoing large-volume (> or = 1 L) thoracentesis. One hundred eighty-five patients undergoing large-volume thoracentesis were included in this study. The volume of fluid removed, absolute pleural pressure, pleural elastance, and symptoms during thoracentesis were compared in patients who did and did not experience RPE. Of the 185 patients, 98 (53%) had between 1 L and 1.5 L withdrawn, 40 (22%) had between 1.5 L and 2 L withdrawn, 38 (20%) had between 2 L and 3 L withdrawn, and 9 (5%) had more than 3 L withdrawn. Only 1 patient (0.5%, 95% confidence interval: 0.01% to 3%) experienced clinical RPE. Four patients (2.2%, 95% confidence interval: 0.06% to 5.4%) had radiographic RPE (diagnosed only on postprocedure imaging without clinical symptoms). The incidence of RPE was not associated with the absolute change in pleural pressure, pleural elastance, or symptoms during thoracentesis. Clinical and radiographic RPE after large-volume thoracentesis is rare and independent of the volume of fluid removed, pleural pressures, and pleural elastance. The recommendation to terminate thoracentesis after removing 1 L of fluid needs to be reconsidered: large effusions can, and should, be drained completely as long as chest discomfort or end-expiratory pleural pressure less than -20 cm H2O does not develop.

Therapeutic thoracentesis: the role of ultrasound and pleural manometry

Therapeutic thoracentesis is one of the most commonly performed medical procedures. The availability of handheld ultrasound machines has greatly enhanced the evaluation and management of patients with pleural effusions, with advantages including the absence of radiation, ease of use, portability and real-time/dynamic imaging. Pleural manometry refers to the measurement of pleural pressure during thoracentesis. Though described more than 122 years ago, most physicians do not measure pleural pressure, or even consider the role pleural pressures plays in the development of pleural effusions. This review summarizes the relevant data behind the use of ultrasound and manometry and explores their use during therapeutic thoracentesis The use of ultrasound has been associated with a higher sensitivity for identifying pleural effusions, avoiding 'near misses' and a lower pneumothorax rate for thoracentesis. Pleural manometry can be used to distinguish patients with lung entrapment from those with trapped lung. Manometry is also able to predict the ability to pleurodesis patients with malignant effusions, and possibly minimize the risk of reexpansion pulmonary edema when large volumes of pleural fluid are removed. The use of ultrasound and pleural manometry enhances the understanding of pleural disease and is associated with clinical benefit that will lead to improved patient care.

Images in emergency medicine

Images in emergency medicine