Tom Franklin was admitted to the surgical intensive care unit (ICU) 8 weeks ago after resection of necrotic bowel due to superior mesenteric artery occlusion. On postoperative day 3 he suffered a cardiac arrest and was resuscitated. Mr Franklin's course since then has been complicated by acute respiratory distress syndrome, stroke, renal failure, and multiple episodes of septic shock. He has a sacral decubitus requiring twice-daily dressing changes, during which he grimaces while his blood pressure and oxygen saturation drop. His decision-making capacity has been intermittent. Throughout Mr Franklin's surgical ICU stay, his care team addressed each acute event and complication with additional treatment interventions.
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