Once upon a time I had a pt like this in our CVICU for >a year. Finally we got a new team of residents in July one of whom had also been chief resident in cardiology and wanted to switch to surg. He also had a wife who was an expert ICU nurse. He figured out that the pt had a low Mg level — who knew? We never paid attn to that and thought he was nuts. But within a week of adding Mg to her TPN she started to turn around, her copious drainage decreased, wound began to granulate, strength improved so we could wean her off the vent. It took another two months but she went home. Moral of the story: fresh eyes, and some picayune detail, can make a lot of difference.