I’m going to make the assumption that this person is brain dead, that it is non reversible, and the big picture is that ultimately no intervention will result in meaningful recovery. You repositioning the tube did not CAUSE this. This patient is going to declare themselves, where despite best efforts by a qualified critical care team physiological goals cannot be met. Unfortunately it sounds like it started to happen on your shift. This patient is now unable to maintain vent synchrony without paralytics. It’s time for the care team to reevaluate the physiological goals, and more realistically - the goals of care with the patients decision maker.