TY - CHAP M1 - Book, Section TI - The Nurse’s Perspective A1 - Schorr, Christa A. A1 - Rubino, Jamie L. A1 - Bergman, Andrew A2 - Lane-Fall, Meghan B A2 - Shapiro, David S. A2 - Kaplan, Lewis J. Y1 - 2024 N1 - T2 - After the ICU: Multidisciplinary Perspectives on Supporting Critical Illness Survivors AB - Patient Care VignetteA 62-year-old male presents to the emergency department (ED) with fever, cough, and body aches for the past 3 days. He has three children and two young grandchildren, works full time in construction, enjoys sporting events and spending time with family. His family states that he was in his usual state of health until 3 days ago when he developed a productive cough, shortness of breath, and confusion. His past medical history includes insulin-dependent diabetes, hyperlipidemia, and hypertension. In the ED, he experienced increasing respiratory distress (difficulty breathing), desaturation to 88% on room air (low blood oxygen), and hypotension (low blood pressure, 82/50 mmHg). His chest X-ray showed bilateral lower lung field infiltrates consistent with pneumonia. He was poorly perfused and had signs of sepsis on examination as well as laboratory profiling. He demonstrated septic shock and acute respiratory failure due to pneumonia clearly establishing critical illness. He was intubated and placed on mechanical ventilation. He required fluid resuscitation, empiric antibiotics to treat pneumonia, as well as a vasopressor to support his blood pressure. Invasive monitoring devices were required to guide care.This patient was admitted to the ICU for critical care. After 24 hours, his lung function worsened, requiring substantial increases in support from the ventilator. Accordingly, he was diagnosed with acute respiratory distress syndrome (ARDS), a condition that may follow many kinds of infections. ARDS is characterized by difficulty clearing carbon dioxide (a waste product) and onloading oxygen across an increasingly stiff lung. In order to help improve gas exchange, he required deep sedation and neuromuscular blockade by continuous infusion, as well as prone position therapy (while on the ventilator he is rolled from his back to his chest, the prone position). This meant that his family could no longer see his face for 16 hours of the day while he was prone, and received no feedback from him indicating that he knew that they had come to visit, hold his hand, and speak to him. The family is distraught having never experienced critical illness with any other family members and is worried that something has gone terribly wrong. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/11/09 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1204537239 ER -