Reexpansion Pulmonary Edema Following Palliative Thoracentesis in a Home Care Setting.

BACKGROUND

In Germany, specialist palliative home care provides care for patients in the home setting. This also includes interventions such as thoracentesis. However, complications such as reexpansion pulmonary edema (REPE), a rare but potentially life-threatening condition, require prompt recognition and management.

CASE PRESENTATION: An 86-year-old woman with metastatic breast cancer under palliative home care developed progressive dyspnea. Despite pharmacological treatment, she required right-sided thoracentesis, yielding 1350 mL of pleural fluid. Within one hour, she experienced acute respiratory distress, coughing, and unilateral crackles. Ultrasound revealed B-lines indicative of REPE. Opioids, oxygen, and intravenous furosemide led to symptom resolution within 24 hours. The patient remained at home and died peacefully 47 days later.

CONCLUSION

REPE is a serious complication in thoracentesis, especially in the home care setting. Awareness of this complication, including its risk factors and warning signs, enables health care professionals to implement preventive strategies, diagnose the condition, and make informed therapeutic decisions.