Review of Case #3 Vincent

Vincent is a 68-year-old retired taxi driver.

He has well controlled high blood pressure and diabetes mellitus and is a former smoker.

He underwent Aortic valve replacement 10 days ago, and on post-operative day 9 the ICU team could not wean him off the ventilator.

He started to have increased secretions that the nurse described as malodorous, thick and greenish.

At the same time, he needed higher oxygen concentration (FiO2) and volumes to reach target oxygen saturation in his blood.

He is tachycardic with bilateral ronchi on auscultation and right lower lobe rales.

Today he has spiked a fever up to 39ºC and his blood pressure dropped significantly.

His blood tests show significant increase in the white blood cell (WBC) count that has risen up to 34,000 WBC/mm³.

A chest x-ray demonstrated a right lower lobe consolidation with air bronchograms and a left lower lobe infiltrate.