Hydrostatic mechanisms may contribute to the pathogenesis of human re-expansion pulmonary edema.
OBJECTIVE
The primary objective was to test the hypothesis that clinical re-expansion pulmonary edema is predominantly due to increased permeability of the alveolar-capillary barrier. A secondary objective was to determine if the alveolar epithelium was functionally intact in patients with re-expansion pulmonary edema by measuring net alveolar epithelial fluid transport in a subset of patients.


METHODS
Retrospective study of mechanically ventilated patients with re-expansion pulmonary edema.


METHODS
Two academic tertiary care hospitals.


METHODS
Seven patients with acute onset of re-expansion pulmonary edema after tube thoracostomy or thoracentesis.


METHODS
Pulmonary edema fluid and plasma were collected at the time of onset of re-expansion edema.


RESULTS
Contrary to our hypothesis, the mean initial edema fluid to plasma protein ratio was 0.58+/-0.21, supporting a hydrostatic mechanism of edema formation. Four of the patients had an initial edema fluid to plasma protein ratio of less than 0.65, consistent with pure hydrostatic pulmonary edema, while the others had a slight increase in permeability (edema fluid to plasma ratios of 0.67, 0.71 and 0.77), perhaps due to capillary stress failure from hydrostatic stress. Alveolar fluid clearance (mean 9.8+/-8.0%/h) was intact in the subset of three patients in whom it was measured.


CONCLUSIONS
This study provides the first direct evidence that hydrostatic forces may contribute to the development of re-expansion pulmonary edema.
Sue
Richard D
RD
Division of Pulmonary and Critical Care Medicine, University of California, 900 Veteran Avenue, 14-154 Warren Hall, Los Angeles, CA 90024-1999, USA.
Matthay
Michael A
MA
Ware
Lorraine B
LB
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002199:Capillary Permeability / Q000502:physiology; D004848:Epithelium / Q000502:physiology; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D008168:Lung / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011650:Pulmonary Alveoli / Q000503:physiopathology; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D013396:Suction; D013907:Thoracostomy
D010100:Oxygen