Cardiac output increases prior to development of pulmonary edema after re-expansion of spontaneous pneumothorax

Pulmonary edema following reexpansion of spontaneous pneurnothorax is an uncommon complication. The underlying mechanism of this condition is unclear. We report the hemodynamic characteristics in a series of 7 male patients with spontaneous large(> 50%) pneumothoraces of > 24 hand correlate the changes with reexpansion pulmonary edema (RIPE). A pulmonary artery floatation catheter was inserted and hemodynamic data were obtained before therapeutic chest tube insertion, I h after chest tube insertion and the following day. Four (57%) patients developed RIPE. There was a tendency for larger pneurnothorax to develop REPE. Capillary wedge pressure did not change significantly I In after the insertion of chest tube in all our patients. Cardiac output increased significantly in patients who developed RIPE compared to those who did not (+1.06 l/min vs -0.27 l/min; P = 0.03) 1 h after insertion of chest tube. One patient did not develop pulmonary edema despite having a large (>80%) pneumothorax. His cardiac output did not rise I h after chest tube insertion. REPE is not an uncommon complication following chest tube drainage in patients with large and long-standing pneumothorax. The increase in cardiac output after chest tube insertion may be associated with subsequent development of REPE. (C) 2002 Elsevier Science Ltd.