Abstract
We report a case of reexpansion pulmonary edema (RPE) with severe hypoxia rescued by using additional nitric oxide (NO) inhalation. A 19-year-old man was admitted to our hospital with non-traumatic pneumohemothorax. On the first day, he underwent thoracoscopic bullectomy; however, 1 hour after surgery, he developed RPE with severe hypoxia. On admission to the ICU, his P/F ratio was 79.8. In spite of using mechanical ventilation with high PEEP, we could not stabilize his oxygenation over the next 12 hours. On the second day, we began administration of inhaled NO. About 30 minutes later, his P/F ratio increased from 72 to 128. The P/F ratio remained over 100 until the fifth day, when we terminated NO administration. This improvement in oxygenation suggested that NO induced vasodilation of pulmonary vessels and increased the blood flow only to well-ventilated areas of the lung. Therefore, additional NO inhalation may be recommended in patients with RPE and severe hypoxia, which is difficult to manage with conventional therapy.
