A 73-Year-Old Woman With a Bounding Barrier to Tracheostomy

A 73-year-old woman with a medical history of morbid obesity, osteoarthritis, and hypertension presented to the ED with shortness of breath. She was found to be positive for COVID-19 and received tocilizumab, dexamethasone, and remdesivir. Unfortunately, her condition progressed rapidly to hypoxemic respiratory failure, and she eventually underwent endotracheal intubation after a short trial of oxygen delivered via high flow nasal cannula. She was admitted to the medical ICU with severe ARDS. After significant clinical improvement, spontaneous breathing trials were initiated on hospital day 10 and repeated daily.