Complications
If the pneumothorax is large and has been present for more than 72 hours, then the patient is theoretically at risk for re-expansion pulmonary oedema after pleural space evacuation. It can also develop in the ipsilateral lung during or immediately following evacuation of air from the pleural space. In addition, the pulmonary oedema may be evident in the contralateral lung. The oedema may progress for 24 to 48 hours. Recovery is typically complete within the first 48 hours.
The exact underlying mechanism for this is not known. Mechanical stress applied to the lung during re-expansion may damage the pulmonary capillaries and lead to the development of pulmonary oedema. Re-perfusion injury with free radical formation may also play a significant role.[109]
It is associated with variable degrees of hypoxaemia and hypotension, sometimes requiring intubation and mechanical ventilation, and occasionally leads to death.[110] Because the amount of intrapleural pressure necessary to induce re-expansion pulmonary oedema is not precisely known, most clinicians err on the side of safety for the patient and connect the chest tubes placed to a water seal device rather than to suction. If the lung does not fully re-expand with the water seal device, negative pressure suction (high-volume low-pressure) can be added.
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