Patient Course

Over the course of the next 4 weeks, the patient slowly improved. Weaning from mechanical ventilation was attempted via SIMV with pressure support and CPAP. Two attempts at extubation failed. He developed pleural effusion on the right and right upper lobe pneumonia. Pseudomonas was cultured from his sputum. Escharotomy was required on all ten fingers. Debridement and skin grafting proceeded without complications. The patient had a tracheotomy during the fourth week and is now on 4 hour trachshield trials throughout the day with mechanical ventilatory support at night.