Chest
Volume 100, Issue 6, December 1991, Pages 1562-1566
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Clinical Investigations
Clinical Analysis of Reexpansion Pulmonary Edema

https://doi.org/10.1378/chest.100.6.1562Get rights and content

Twenty-one of 146 cases of spontaneous pneumothorax that were treated by thoracentesis or continuous low negative pressure suction drainage (−12 cm H2O) of the pleural space developed REPE. The rate of REPE was higher in patients 20 to 39 years of age than in those over the age of 40, and the rate progressively increased in proportion to the extent of pneumothorax, as assessed by roentgenographic criteria. It is postulated that age-related changes in the lung may afford some degree of protection against developing REPE. It is also suggested that the treatment of pneumothorax with thoracentesis and/or suction drainage in young patients, or in the face of a large pneumothorax, requires careful consideration in view of a relatively high incidence of REPE in such individuals.

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MATERIALS AND METHODS

The subjects in this study were 164 patients with spontaneous pneumothorax, 146 of whom were treated by thoracentesis or continuous low negative pressure drainage (−12 cm H2O) of the pleural space. Subsequently, 113 underwent a thoracotomy for bleb excision and/or pleurectomy. The remaining 18 patients received conservative treatment (bedrest), and the condition was allowed to resolve spontaneously. Among the 146 patients who received active treatment, 21 developed REPE. The criteria used to

RESULTS

Treatment modalities utilized are outlined in Table 1. Initial treatment consisted of thoracentesis or continuous negative pressure drainage. The most frequently performed surgical treatment was excision of bleb with parietal pleurectomy in patients under the age of 50. Patients who were over 60 years old were most commonly treated by simple continuous low negative pressure suction drainage. Figure 1 shows the rate of cases of subgroups classified by severity of pneumothorax according to age.

DISCUSSION

It has been suggested that the incidence of REPE is a rare condition.4 However, Hosokawa and associates5 reported that they experienced three cases of REPE among 12 treated cases of spontaneous pneumothorax, and Takamura and his associates6 found a 27 percent incidence of REPE in experimental study. In our series, 21 of 146 (14.4 percent) cases treated by thoracentesis or suction drainage or both of the pleural space developed REPE. Mahfood and associates7 reported 11 fatalities among 53 cases

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Manuscript received November 8; revision accepted March 26.

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