70 - year - old female, day 10 in ICU, following an elective AAA repair, with on - going requirements for mechanical ventilation. Clinical signs included the presence of confusion but with no focal neurological deficits, normal cardiorespiratory exam ination, large NG aspirates and TPN, anuria and CRRT, ischaemic toe and new onset fever. Candi dates were asked to examine her and identify reasons for a difficult wean from ventilatory support.