{
  "abstract": "Background Re-expansion pulmonary oedema (RPO) is a serious and potentially life-threatening complication following rapid drainage of pleural effusion or pneumothorax. However, the incidence and risk factors for RPO following medical thoracoscopy (MT) remains unknown.Methods We performed a retrospective cohort study of patients who underwent MT between January 2017 and December 2024. All procedures were performed with a semirigid thoracoscope under conscious sedation.Results A total of 362 patients were included in the study. Approximately half (52.8%) of patients had pleural effusions occupying >50% of the hemithorax on preprocedural chest radiographs. Malignant pleural effusion and tuberculous pleuritis accounted for 85.1% (n=308) and 8.6% (n=31) of the final diagnoses, respectively. Six (1.7%) patients developed clinical RPO with hypoxia requiring oxygen supplementation, of whom three required invasive mechanical ventilation, and one patient required non-invasive ventilation. Compared with patients without RPO, those who developed clinical RPO were younger in age (median 55 (IQR: 35–64) vs 69 (IQR: 60–75) years, p=0.031), had a higher proportion of effusions occupying >50% hemithorax (100% (6/6) vs 52.0% (185/356), p=0.031) and greater pleural fluid drainage volumes during MT (median 2795 (IQR:1425–4050) vs 1375 (IQR:1000–1831) mL, p=0.009). Radiological RPO occurred in 20 patients (6.1%). On univariable and multivariable analysis, younger age (<60 years), larger volume of pleural fluid drained and expandable lung following pleural fluid drainage were associated with the development of radiological RPO. There were no deaths related to MT or RPO in our study.Conclusion RPO is a clinically significant complication of MT, with younger age and large-volume effusions being possible risk factors. Physicians performing MT should exercise vigilance for RPO to facilitate early recognition and prompt management.",
  "authors": [
    {
      "affiliations": [
        "Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"
      ],
      "name": "Ken Junyang Goh"
    },
    {
      "affiliations": [
        "Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"
      ],
      "name": "Mei Ting Lim"
    },
    {
      "affiliations": [
        "Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"
      ],
      "name": "Brian Lee Wei Chua"
    },
    {
      "affiliations": [
        "Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"
      ],
      "name": "Qiao Li Tan"
    },
    {
      "affiliations": [
        "Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"
      ],
      "name": "Carrie Kah-Lai Leong"
    },
    {
      "affiliations": [
        "Division of Nursing, Singapore General Hospital, Singapore"
      ],
      "name": "Jane Jing Yi Wong"
    },
    {
      "affiliations": [
        "Division of Nursing, Singapore General Hospital, Singapore"
      ],
      "name": "Ivana Gilcrist Chiew Sian Phua"
    },
    {
      "affiliations": [
        "Division of Nursing, Singapore General Hospital, Singapore"
      ],
      "name": "Wen Ting Lim"
    },
    {
      "affiliations": [
        "Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"
      ],
      "name": "Si Ling Young"
    }
  ],
  "title": "Incidence and risk factors for re-expansion pulmonary oedema following medical thoracoscopy",
  "uid": "9f6eaded-2d8b-5394-87d7-2bee2d7ee0c9"
}