Joseph has had cough, fever, and painful respirations for 2 days. He also has congestive heart failure and COPD. Joseph presents to the emergency department with severe shortness of breath, using accessory muscles to assist with breathing. Upon examination, Joseph is diagnosed with acute respiratory failure, congestive heart failure, pneumonia, and exacerbation of COPD. Joseph is intubated and placed on mechanical ventilation. He is weaned from the ventilator on the third day of admission. Two days later, he again goes into respiratory failure, requiring reintubation and placement on the ventilator. Fortunately, he is able to breath on his own the following day, so was extubated.