Re-expansion Pulmonary Oedema — FRCA Final MCQ

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ModerateIntensive Care MedicineRe-expansion Pulmonary OedemaFRCA Final

A 60-year-old man (ASA III) in ICU has a chest drain for a large pleural effusion. One litre is drained rapidly. He then develops severe cough, desaturation, and hypotension. CXR shows new ipsilateral pulmonary infiltrates. What complication has occurred?

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Correct answer: B — Empyema

Re-expansion pulmonary oedema (RPO) occurs when a chronically collapsed lung is re-expanded too rapidly. It presents within 1-2 hours of drainage with cough, hypoxia, hypotension, and unilateral pulmonary infiltrates on the ipsilateral side. The mechanism involves increased permeability of the pulmonary microvasculature that has been chronically compressed. Prevention: drain pleural fluid slowly (no more than 1-1.5L at a time), use a controlled drainage system, and monitor for symptoms. Severe cases require intubation and ventilation with lung-protective settings.

Reference: BTS – 2023 – Pleural disease guidelines; ICS – 2023 – Pleural procedures in ICU