DR NEEDHAM: Mr E is a 56-year-old man with severe chronic obstructive pulmonary disease. He was recently admitted to the Johns Hopkins Hospital (Baltimore, Maryland) with acute renal failure. Three days later, he was transferred to the medical intensive care unit with acute respiratory failure requiring mechanical ventilation. Mr E had a complicated 2-month medical intensive care unit stay that included aspiration, sepsis, and significant weight loss. He was discharged from the medical intensive care unit to an acute rehabilitation facility for ventilator weaning and physical rehabilitation. After approximately 6 weeks in rehabilitation, he was discharged home.