I work in a 26 bed nsicu teaching hospital. As will happen, my open bedded turned from a s/p embo for aneurysm to an aborted fusion. They ended up finishing Only a few levels d/t 4.5 liters blood loss, plan is for stage II on Monday. So the pt. Comes back with anesthesia intubated and they are messing with the vent trying to get her settled. They ended up putting her on pressure support, as she was starting to wake up.
Neurosurg comes by and wants to hold sedation for exam, I saw her move all ext to command but Neurosurg wanted a good exam. So we wait for her to wake up, she's gagging on the tube and bucking the vent as we wait. CXR is done, Neurosurg says to CC wean to extubate... By now it's 1830, change of shift is coming. CXR come back, RUL is collapsed. And here is me, trying to get anesthesia to put this pt on a rate so I can sedate her, she did just have high risk spine surgery, and lost 4.5 liters of blood. And all they want me to give her for pain is 25mcgs/hr of fent. We generally have our high risk spines down all night, prop/fent. While we transfuse.
So I left @ 2000, pt was fine, corrected her coags before I left and was wide awake with 50 of fent going. I'm questioning if it was even reasonable to think that they wanted to extubate this patient that night given 4.5 liters EBL, aborted case, and her RUL collapse. Oh, and we chcked a bladder pressure on her ~ 22