A simple chest drain gone wrong: a near miss!

This is a case of a 45-year-old woman, with known alcoholic liver disease who presented with a large right-sided pleural effusion. A pleural tap was performed followed by insertion of an intercostal drain. 7 litres were drained over 4 h and only 300 ml of 20% albumin were administered with the patient becoming acutely short of breath and requiring admission to the intensive treatment unit due to the development of the known and recognised complication of re-expansion pulmonary oedema. The patient required continuous positive airway pressure in an intensive care setting but made a good recovery. It is important to consider re-expansion pulmonary oedema in patients who become acutely short of breath during drainage of pleural fluid or air. Steps should be made to ensure that drainage of large volumes of fluid are performed in a controlled manner to avoid this preventable complication.