International Journal of Academic Medicine

LETTERS TO EDITOR
Year
: 2017  |  Volume : 3  |  Issue : 3  |  Page : 209-

Authors' Reply


Stanislaw P Stawicki1, Babak Sarani2, Benjamin M Braslow2,  
1 OPUS 12 Foundation, Pennsylvania Chapter, PA, USA
2 Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Correspondence Address:
Stanislaw P Stawicki
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania
USA




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


How to cite this URL:
Stawicki SP, Sarani B, Braslow BM. Authors' Reply. Int J Acad Med [serial online] 2017 [cited 2022 May 28 ];3:209-209
Available from: https://www.ijam-web.org/text.asp?2017/3/3/209/204964


Full Text



 Counterpoint: Reexpansion Pulmonary Edema and Diuresis



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

1Cairncross L, Nicol AJ, Navsaria PH. Bilateral reexpansion pulmonary oedema following trauma: A case report. Inj Extra 2005;36:203-5.
2Feller-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.
3Heller BJ, Grathwohl MK. Contralateral reexpansion pulmonary edema. South Med J 2000;93:828-31.
4Iqbal 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.
5Matsuura Y, Nomimura T, Murakami H, Matsushima T, Kakehashi M, Kajihara H. Clinical analysis of reexpansion pulmonary edema. Chest 1991;100:1562-6.