[Treatment of re-expansion edema ('unilateral ARDS") after rapid pneumothorax drainage].
A rare complication after delayed re-expansion of pneumothorax is reported. A polytraumatized patient with stable vital functions was admitted to our ICU immediately after surgery. Later, oxygenation worsened treated by a rise in FiO2. Concomitant tachycardia was thought to be due to increasing body temperature. On day 3 of treatment in the ICU further deterioration in gas exchange (and in hemodynamics, with complete collapse of the left lung) was diagnosed on X-ray examination. Retrospectively, the development of this condition could be traced on the X-ray films taken during the previous 3 days. Thoracic drainage and suction resulted in complete re-expansion of the lung. After re-expansion worsening of gas exchange and unilateral ARDS-like configurations were observed on chest X-ray. Reversal of the I:E ration and a rise in PEEP improved gas exchange and the X-ray appearance immediately. In the next few days the intensity of the respiratory treatment could be reduced, and after a short period of CPAP the patient was discharged from the ICU. Three mechanisms for development of this "unilateral ARDS" are discussed: loss and suppressed regeneration of surfactant in prolonged atelectic alveolar compartments; increased capillary fluid escape due to suction; and increased complement activation and reduced degradation of edematogenic bradykinin in hypoxic alveolar compartments. Possible clinical implications for the treatment of longer duration pneumothorax are: fractionated drainage and respirator settings, reopening collapsed alveoli in an inhomogeneously diseased lung such as IRV.
Klinik für Anaesthesiologie, Universität Innsbruck.
W
W
Koller
N
N
Mutz
C
C
Putensen
G
G
Putz
D000328:Adult; D003422:Critical Care; D004322:Drainage; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000628:therapy*
Behandlung eines Reexpansionsödems ("einseitiges ARDS") nach rascher Pneumothoraxdrainage.