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Is the mechanism of re-expansion pulmonary oedema in a heart–lung interaction?
  1. Candy Masego Mokotedi,
  2. Martin Balik
  1. Department of Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University, Prague, Czech Republic
  1. Correspondence to Dr Martin Balik, martin.balik{at}


The mechanism of re-expansion pulmonary oedema (Re-PE) is unclear. There are multiple variables in play when evaluating the response to evacuation of pleural fluid. We present an educational case of a critically ill patient admitted for respiratory failure who was fully dependent on ventricular pacing set at a constant rate throughout the episode of Re-PE. The transthoracic echocardiography (TTE) showed an ejection fraction of 38%, moderate mitral regurgitation (MR), mildly dilated right ventricle and moderate pulmonary hypertension. A pleural tap evacuated 850 mL of transudate, which was followed by tachypnoea and deteriorating oxygenation. Another repeat TTE revealed a Re-PE with elevated left ventricular end-diastolic pressure, severe MR, increased pulmonary hypertension and a decrease in stroke volume. There were no parallel changes in ventilation modality, heart rate, fluid therapy and vasopressor dosage. The treatment was initiated with dobutamine. The patient was extubated the next day and was later discharged to the cardiology department.

  • lung function
  • adult intensive care
  • heart failure
  • mechanical ventilation

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  • Contributors CMM is a postgraduate student in the field of Imaging methods at the 1st Medical Faculty of the Charles University in Prague. MB, CMM’s tutor and Head of the Intensive Care Unit of the Department of Anaesthesia and Intensive Care, General University Hospital in Prague, performed the echocardiographic examination and reviewed the original data. They both contributed to the write up of the manuscript.

  • Funding The study was supported inpart from CZ.2.16/3.1.00/21565 from OP Prague Competitiveness.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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