Geriatrics

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A 72-year old man with an 80 pack-year smoking history is admitted to the surgical intensive care unit (SICU) for exacerbation of COPD after elective cholecystectomy. He has no history of dementia, depression or other cognitive disorder; score on Mini-Mental 1 month ago was 30 of 30. He is started on inhaled albuterol prn, fluticasone/salmeterol, intravenous dexamethasone, intravenous ceftriaxone, and supplemental oxygen. He becomes increasingly anxious. Oxygen saturation decreases, and he is started on lorazepam 0.5mg IV. Oxygen saturation reaches 93% with 35% venti mask. He improves overnight and into the next day. At the beginning of day 3 in the SICU, staff notes that he is inattentive and more confused. He becomes fatigued during the day and increasingly confused and hypervigilant toward evening and overnight. He refuses breathing treatments and pulls out intravenous lines; he undergoes intubation for airway protection. On day 12 in SICU, he undergoes tracheotomy. He is discharged from the SICU on day 15, with symptoms and signs of delierium. Which of the following may have prevented the prolonged stay in the SICU?

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