In the ICU, HFNO (high-flow nasal oxygen therapy) and selective digestive decontamination (SDD) were initiated, which includes ceftriaxone i.v. 2000 mg q24h for 4 days and a combined oral non-absorbable suspension of amphotericin B, colistin and tobramycin q6h. In this patient, ceftriaxone was continued de facto for another 4 days. Routine bacterial and fungal (peri-anal, throat and tracheal aspirate) surveillance cultures were done twice weekly in adherence with our local SDD policy [13]. Within a few hours after admission to the ICU, her blood oxygenation became insufficient with HFNO at FiO2 100% and 60 L/min flow. Therefore, she was sedated, intubated and put on a mechanical ventilator. A CT angiography of the chest was performed which demonstrated significant bilateral pulmonary emboli. Anticoagulants (enoxaparine anti-factor Xa) were initiated in therapeutic dosages. Pressure control ventilation was required with the patient in prone position. Because of the need for increasing noradrenaline dosages during circulatory shock, hydrocortisone 100 mg q8h was initiated and continued for five days. Cardiac ultrasound showed a minor tricuspid insufficiency but no major pathology.