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 Table of Contents  
LETTERS TO EDITOR
Year : 2017  |  Volume : 3  |  Issue : 3  |  Page : 209

Authors' Reply


1 OPUS 12 Foundation, Pennsylvania Chapter, PA, USA
2 Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Date of Web Publication21-Apr-2017

Correspondence Address:
Stanislaw P Stawicki
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-5568.204964

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How to cite this article:
Stawicki SP, Sarani B, Braslow BM. Authors' Reply. Int J Acad Med 2017;3, Suppl S1:209

How to cite this URL:
Stawicki SP, Sarani B, Braslow BM. Authors' Reply. Int J Acad Med [serial online] 2017 [cited 2020 Nov 24];3, Suppl S1:209. Available from: https://www.ijam-web.org/text.asp?2017/3/3/209/204964




  Counterpoint: Reexpansion Pulmonary Edema and Diuresis Top


Dr. Aggarwal brings up a very important question: “Is diuresis detrimental or helpful in the setting of reexpansion pulmonary edema (RxPE)?” In the original article, we reported that careful diuresis is one of many treatment modalities that can be considered in the setting of RxPE. We continue to support this position, with certain clarifications that were not included in the original article.

We agree that empiric diuresis in the setting of RxPE may indeed be detrimental. In any clinical setting, administration of diuretics should be considered with great caution, and some combination of resuscitation endpoints (clinical; hemodynamic; laboratory – lactic acidosis, base deficit, etc., invasive line monitoring – pressure, stroke volume measurements; echocardiographic – left ventricular status) should be followed while the patient is undergoing diuresis. Further, if a patient with acute RxPE demonstrates clinical signs of fluid sequestration and intravascular volume depletion, diuretics would be contraindicated.

Just as much as we agree that diuresis should not be used in the setting of RxPE when not clinically indicated, we generally disagree with the statement that all diuresis is detrimental in the setting of RxPE. In fact, there are numerous reports of the successful adjunctive use of diuresis in the setting of RxPE, with good clinical results and no reported adverse events.[1],[2],[3],[4],[5] Because judicious and appropriate administration of diuretics in the setting of RxPE appears to be associated with satisfactory outcomes, we continue to support the use of diuresis in this setting provided that the patient does not demonstrate any signs of hypovolemia or ongoing need for volume resuscitation. Again, it is important to continue to monitor clinical, laboratory, and other endpoints of resuscitation while the patient is undergoing diuresis.

We hope that we addressed Dr. Aggarwal's questions adequately and that we were able to clarify major points relevant to the discussion of diuretic use in the setting of RxPE.

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.



 
  References Top

1.
Cairncross L, Nicol AJ, Navsaria PH. Bilateral reexpansion pulmonary oedema following trauma: A case report. Inj Extra 2005;36:203-5.  Back to cited text no. 1
    
2.
Feller-Kopman D, Berkowitz D, Boiselle P, Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg 2007;84:1656-61.  Back to cited text no. 2
    
3.
Heller BJ, Grathwohl MK. Contralateral reexpansion pulmonary edema. South Med J 2000;93:828-31.  Back to cited text no. 3
    
4.
Iqbal M, Multz AS, Rosoff LJ, Lackner RP. Reexpansion pulmonary edema after VATS successfully treated with continuous positive airway pressure. Ann Thorac Surg 2000;70:669-71.  Back to cited text no. 4
    
5.
Matsuura Y, Nomimura T, Murakami H, Matsushima T, Kakehashi M, Kajihara H. Clinical analysis of reexpansion pulmonary edema. Chest 1991;100:1562-6.  Back to cited text no. 5
    




 

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