A 32-year-old woman who had been admitted to the hospital for menometrorrhagia underwent an uneventful dilation and curettage, and polypectomy. Her medical history was significant for polycystic ovarian syndrome, depression, chronic postnasal drip, and obesity. Shortly after undergoing surgery, while recovering from anesthesia, the patient became apneic and hypotensive. Excessive resistance to mask/bag manual ventilation was encountered, and the patient was reintubated. Bloody secretions emanating from the endotracheal tube were immediately observed. Mechanical ventilation was initiated using the assist-control mode with a tidal volume (Vt) setting of 800 mL, a respiratory rate (RR) of 12 breaths/min, a fraction of inspired oxygen (Fio2) of 1.0, and a PEEP of 10 cm H2O, and was facilitated by heavy sedation and neuromuscular paralysis. Lung compliance was 31 mL/cm H2O. Arterial blood gas measurements with these settings revealed a pH of 7.28, a Pco2 of 51 mm Hg, and a Po2 of 59 mm Hg. A chest radiograph showed the presence of bilateral pulmonary infiltrates. The patient developed fever (temperature, 102.9°F) and hypotension, for which therapy with a decongestant (Neosynephrine; Abbott Laboratories; Abbott Park, IL) at 125 μg per hour was started. Over the next 12 h, the patient continued to have difficulty with oxygenation, with a Pao2 of 49 mm Hg, an Fio2 of 1.0, and a PEEP of 10 cm H2O. Lung compliance decreased from 31 to 20 mL/cm H2O. The decision was made to transfer the patient to a tertiary referral center.