Experimental evaluation of reexpansion pulmonary edema

Reexpansion pulmonary edema following pneumothorax is clinically uncommon but occasionally life threatening. This study documents the functional and anatomical abnormalities that occur when a collapsed lung is reexpanded. Right pneumothorax was created through open tube thoracostomy in 30 goats. The animals were divided into six groups by duration of pneumothorax (24, 48, or 72 hours) and technique of reexpansion (waterseal vs 10 cm H2O suction). Arterial blood gases and alveolar-arterial oxygen tension difference (A-aDO2) were analyzed before pneumothorax and after reexpansion. Each lung was reexpanded for 2 hours, chest roentgenograms were obtained, and both lungs were removed. The left lung served as the control. Both lungs were checked for surfactant activity and pulmonary extravascular water volume (PEWY). Light and electron microscopy were also performed. Anatomical and functional changes were present in the reexpanded lung after relief of pneumothorax. Both increased time of collapse and suction reexpansion tended to correlate with increased PEWV, decreased surfactant and arterial PO2, and increased A-aDO2.