Intraoperative reexpansion pulmonary edema “REPE” following thoracoscopy by one lung ventilation

Abstract

The sudden pulmonar expansion which has remained collapsed among different hours or days, likewise the fast pneumothorax or pleural effusion drainage, can cause a flash or acute edema on the affected lung.

It is believed that the rexpansive pulmonary syndrome (REPE), is caused due to an increment in the capillary permeability after being exposed the affected lung to high negative intra-pleural pressure.

The ocurrence of REPE is a rare event with most cohort studies reporting an incidence of between 0%- 1%. It may extend with hypoxaemia, hypotension and even cardiac arrest.

The treatment of these patients include mechanical ventilation with optimal PEEP levels, the use of vasopressors and an intesive electrolyte resuscitation.

We expose the case of a 16 year old patient with mediastinal mass diagnosis and massive left-pleural effusion, where after a thorascocopy for biopsy and pleuritic drainage, it is observed a reexpansion pulmonary edema with respiratory repercussion, haemodynamics and the requirement of endotracheal reintubation.