<![CDATA[Background: The coronavirus disease (COVID-19) pandemic has posed significant challenges in critical care, particularly for patients with severe acute respiratory distress syndrome (ARDS), ventilator weaning failure, and septic shock requiring tracheostomy. Case Presentation: This report presents the clinical course and nursing management of Mrs. X, a COVID-19 patient who presented to the emergency department with severe dyspnea, hypoxia (SpO2 69%), and tachypnea (30 breaths/min). Despite initial noninvasive ventilation (NIV), her condition deteriorated, requiring endotracheal intubation and intensive care unit (ICU) admission. She was diagnosed with moderate ARDS (P/F ratio: 146 mmHg) and ventilator weaning failure after 15 days, leading to tracheostomy. Results: Key nursing diagnoses included impaired spontaneous ventilation and impaired gas exchange. ICU nurses implemented comprehensive tracheostomy care, adhered to ventilator-associated pneumonia (VAP) prevention bundles, and performed continuous assessments to minimize infection risks. These interventions successfully prevented common tracheostomy-related complications such as ulcers and site infections. However, the patient developed septic shock and multiple organ dysfunction syndrome (MODS), ultimately resulting in death on the 27th day of admission. Conclusion: This case highlights the essential role of ICU nursing in managing complex COVID-19 patients with tracheostomy. Effective tracheostomy care, stringent infection control, and timely nursing interventions are crucial to optimizing patient outcomes. Nevertheless, the progression to septic shock underscores the challenges of managing critically ill patients with COVID-19.Keywords: COVID-19, nursing care, critical care, ventilator weaning, tracheostomy, ARDS]]>
