Critical Conversations Prolonged Mechanical Ventilation

Case:Mrs. Smith is an 85-year-old woman with longstanding chronic kidney disease (NKF Stage 5, <15 mL per 1.73 m2) who has been on hemodialysis for the past year. She is admitted to the intensive care unit from the community with acute respiratory distress syndrome. Her comorbidities include diabetes and hypertension (JNC7 Hypertension, Stage 2). The patient receives empiric treatment for health-care-associated pneumonia but remains ventilator dependent and on a high FIO2 after 2 weeks. The patient is off vasopressors.