We don't really know at this point. I was in 20 minutes prior and he had no complaints. He was doing his usual cough, vitals were the same (on levo). He was joking around with me, as he had been all night. O2 sats mid 90s. Urine output at been marginal all night (renal failure). The PA was in discussing code status 30-40 minutes prior. I came in and he was dusky, tachy, and talking. Called my charge, ordered stat ABGs, but before we got them he became unresponsive. He was going to be made a no code later, but wanted to wait til his sister got there. His renal panal was unchanged from the day before, his CBC showed he was dry (3rd spacing all day. MD aware), but his ABGs showed acidosis. PH 7. He had made statements throughout the day regarding death. When I did my 4am assessment I commented that he still sounded congested, but no worse than earlier. He said "I know. Sweetie I'm dying." (that was when I called about the code talk again and the PA came to talk to him). I think it gets to me because he just wanted to wait for his sister, then he was going to be a no code. He didn't want interventions, but it wasn't going to become an official order until the afternoon. When he looked at me it was like "What the hell did you do to me?" Part of me wonders if he had denied something important because he gave up and was ready to go.
When the day shift MD got there he wasn't fully sedated yet and she talked to him for a while. He was answering yes and no appropriately and was expressing he wanted to be extubated and understood he'd die. They withdrew the pressors and extubated around 830.