A man in his 80s with hypertension and type 2 diabetes was admitted to the intensive care unit (ICU) with acute hypoxic respiratory failure secondary to COVID-19. He experienced a protracted medical course requiring multiple intubations, complicated by ventilator-associated pneumonia and a pneumothorax necessitating chest tube placement. In total, he was intubated for 19 days.
While intubated, he frequently pulled at tubes and lines. Hospital staff had difficulty redirecting him and expressed concerns about reaching him quickly owing to respiratory isolation precautions. To address his ICU delirium, sedating medications were adjusted and adjunctive medications added. However, these changes were only moderately effective. The patient self-extubated and was reintubated on an emergency basis. Physical restraints were subsequently added.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Mary K. Finta, MD, Department of Internal Medicine, Michigan Medicine, 1500 E Medical Center Dr, 3116 Taubman Center, SPC 5368, Ann Arbor, MI 48109 (email@example.com).
Published Online: December 13, 2021. doi:10.1001/jamainternmed.2021.7165
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient’s wife for granting permission to publish this information.
Additional Information: Dr Finta was an internal medicine resident at the time of preparation and submission of the manuscript. Dr Yeow is a cardiology fellow and was a JAMA Internal Medicine Teachable Moment Editorial Fellow at the time of preparation and submission of the manuscript.
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