“Why?” Jake asked.
Jake smiled. “It worked.”
They intubated Letitia smoothly. Post-intubation ABG: pH 7.33, PaCO₂ 45, PaO₂ 78. Better. abg tocil
“Respiratory acidosis. Acute on chronic? No—HCO₃ is normal. This is acute hypercapnic failure. Her muscles are exhausted,” Maya said.
It was 3:17 AM in the Medical ICU when the pagers went off. “Bed 4, ABG in 20.” “Why
“Yes. But look at her CRP and IL-6 from this morning. They’ve tripled.” Maya scrolled through the chart. “She’s not just fatigued. She’s in a cytokine storm.”
But Maya stared at the chart. “Look at the PaCO₂. 38. That’s low for a paralyzed patient. She’s breathing over the vent.” Post-intubation ABG: pH 7
“Tocilizumab calmed the storm,” Maya said, writing antibiotics orders. “But it also let her body feel well enough to breathe hard against the vent. Without that second ABG, we’d have missed the VAP until she crashed.”