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 Table of Contents  
LETTERS TO EDITOR
Year : 2017  |  Volume : 3  |  Issue : 3  |  Page : 208

Republication: Point-counterpoint correspondence regarding the role of diuresis in management of reexpansion pulmonary edema


Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India

Date of Web Publication21-Apr-2017

Correspondence Address:
Deepak Aggarwal
Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_8_17

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How to cite this article:
Aggarwal D. Republication: Point-counterpoint correspondence regarding the role of diuresis in management of reexpansion pulmonary edema. Int J Acad Med 2017;3, Suppl S1:208

How to cite this URL:
Aggarwal D. Republication: Point-counterpoint correspondence regarding the role of diuresis in management of reexpansion pulmonary edema. Int J Acad Med [serial online] 2017 [cited 2020 Sep 25];3, Suppl S1:208. Available from: http://www.ijam-web.org/text.asp?2017/3/3/208/204963




  Point : Reexpansion Pulmonary Edema Management Issues Top


Stawicki and et al.[1] have nicely elaborated the points and concepts on reexpansion pulmonary edema (RxPE). This condition, though well-documented as well as encountered by physicians at all the levels of health care, is still less appreciated and poorly managed. Some points in this article need further discussion so that the entity is better understood.

The authors have advocated the use of careful diuresis as one of the treatment modalities for RxPE. Whereas, according to available literature, the condition is mainly caused by an alteration in capillary permeability [2] due to hypoxic [3] and mechanical damage [2] to alveolar–capillary membrane. This leads to extravasation of protein-rich fluid out of the blood vessels into the lung tissue. Increased hydrostatic pressure plays a less important role in the development.[4],[5] Moreover, due to movement of fluid out of blood vessels, there is a state of hypovolemia which presents clinically in the form of tachycardia, hypotension, and oliguria. Hence, the use of diuretics in such circumstances is not likely to be beneficial in any way. The use of diuretics in the treatment of this condition is not generally recommended, and they may even deteriorate the condition.[6] There has also been case report of fatal results with its use.[7] Furthermore, use of term “careful diuresis” does not give a clear picture to the readers.

Even though, there is vast literature available, the pathophysiological mechanisms and management of this preventable complication are still the areas of active research. There is vast scope for us to learn from the available literature so that the condition is better understood and effectively managed. In addition, more research is needed to elucidate the less clear aspects of this entity.

Acknowledgement

Justifications for re-publishing this scholarly content include: (a) The phasing out of the original publication after a formal merger of OPUS 12 Scientist with the International Journal of Academic Medicine and (b) Wider dissemination of the research outcome(s) and the associated scientific knowledge.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Stawicki SP, Sarani B, Braslow BM. Reexpansion pulmonary edema. OPUS 12 Sci 2008;2:29-31.  Back to cited text no. 1
    
2.
Mahfood S, Hix WR, Aaron BL, Blaes P, Watson DC. Reexpansion pulmonary edema. Ann Thorac Surg 1988;45:340-5.  Back to cited text no. 2
    
3.
Kernodle DS, DiRaimondo CR, Fulkerson WJ. Reexpansion pulmonary edema after pneumothorax. South Med J 1984;77:318-22.  Back to cited text no. 3
    
4.
Genofre EH, Vargas FS, Teixeira LR, Vaz MA, Marchi E. Reexpansion pulmonary edema. J Pneumol 2003;29:101-6.  Back to cited text no. 4
    
5.
Mahajan VK, Simon M, Huber GL. Reexpansion pulmonary edema. Chest 1979;75:192-4.  Back to cited text no. 5
    
6.
Henderson AF, Banham SW, Moran F. Re-expansion pulmonary oedema: a potentially serious complication of delayed diagnosis of pneumothorax. Br Med J (Clin Res Ed) 1985;291:593-4.  Back to cited text no. 6
    
7.
Trapnell DH, Thurston JG. Unilateral pulmonary oedema after pleural aspiration. Lancet 1970;1:1367-9.  Back to cited text no. 7
    




 

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