“She is —the vent just isn’t showing it because it’s set to A/C with a backup rate. Do a manual breath hold.” Maya disconnected the circuit for five seconds. The patient coughed.
It was 3:17 AM in the Medical ICU when the pagers went off. “Bed 4, ABG in 20.”
“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.”
Maya answered, “Because tocilizumab blocks IL-6 receptors. It can lower CRP dramatically—but it can also mask signs of superinfection. The ABG will tell us if her oxygenation improves or if she’s silently getting worse.”
They ran it to the blood gas analyzer. Two minutes later, the results printed:
They intubated Letitia smoothly. Post-intubation ABG: pH 7.33, PaCO₂ 45, PaO₂ 78. Better.
That’s when the attending, Dr. Vance, appeared. He glanced at the ABG. “Call pharmacy. She gets now. But first—we need one more ABG post-intubation, then another 6 hours after tocilizumab.”
“Respiratory acidosis. Acute on chronic? No—HCO₃ is normal. This is acute hypercapnic failure. Her muscles are exhausted,” Maya said.
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