Fever dreams: demons and nightmares in an ICU bed

Wrought with night sweats and the vivid machinations of a brain on fire, a 70-year-old male with a history of diabetes and coronary artery disease presents to the emergency department with fevers and progressive hypoxemia requiring supplemental oxygen.He is confused and not oriented to time or place.Upon testing, he is diagnosed with influenza A, and his chest X-ray has bilateral infiltrates.Due to the severity of his illness, he is admitted to the intensive care unit (ICU).Over the next 24 h, he is intubated and mechanically ventilated.He is deeply sedated with propofol and fentanyl.He experiences intermittent confusion and significant nighttime agitation mixed with episodes of complete somnolence and limited interaction.These symptoms last for several days, for which he is treated with haloperidol.Approximately 1 week into his hospital course, he is extubated.He has occupational and physical therapy ordered, though his rehabilitation sessions are limited by ongoing drowsiness, distressing hallucinations, and difficulty remaining alert.He ultimately survives and is discharged home.In follow-up with his primary care physician, he notes difficulties with recalling appointments, focusing on tasks, and reports short-term amnesia and fading memory.