Pulmonary Disorders I

(goal central venous pressure less than 4 mm

Hg), and vasopressors for shock; low tidal vol-

ume (4–8 mL/kg) ventilation strategy; deep

sedation to achieve a RASS score of −4; and

prone positioning.

resuscitation, and vasopressors for shock; low

tidal volume (4–8 mL/kg) ventilation strategy;

deep sedation to achieve a RASS score of −4;

and supine positioning.

P.D. is a 67-year-old woman (height 160 cm; total

body weight 68 kg) admitted to the ICU with ARDS

pneumonia. Her mechanical ventilation parameters

are as follows: tidal volume 280 mL, respiratory rate

20 breaths/minute, positive end-expiratory pressure

(PEEP) 12 cm H2O, and Fio2 80% with plateau

pressure of 22 mm Hg. Her mean arterial pressure

(MAP) is currently 68 mm Hg with norepinephrine

discontinued 4 hours ago and CVP ranging between

8 and 14 cm H2O over the last 2 hours. Also, her

total urine output over the past 24 hours is 1150 mL.

The ICU team is discussing fluid management using

the FACTT Lite protocol. Which of the following

options is the most appropriate strategy?

evaluate in 4 hours.

sion and re-evaluate in 8 hours.

1 hour and re-evaluate in 4 hours.

Which of the following statements most appro-

priately describes published clinical trials of

corticosteroids in ARDS?

demonstrated

improved

clinical outcomes among ARDS patients on

lung-protective strategies.

onset was associated with worse clinical

outcomes.

clinical outcomes among ARDS patients on

lung-protective strategies.

ARDS onset was associated with worse clinical

outcomes.

Which order of medication administration would be

most appropriate for a 34-year-old woman with no

significant medical history receiving rapid sequence

intubation (RSI)?

A 78-year-old man (weight 70 kg) presents to the

ICU after being intubated for acute respiratory

failure. His ventilator settings are as follows: assist

control/volume control mode, tidal volume 700

mL (10 mL/kg), respiratory rate 20 breaths/minute,

Fio2 50%, PEEP 5 cm H2O, and pressure support

10 cm H2O. The first arterial blood gas values are

pH 7.25, Paco2 65 mm Hg, HCO3 26 mEq/L, Pao2

65 mm Hg, and Sao2 90%. His MAP is 72 mm Hg

without requiring vasoactive support, with a serum

creatinine of 1.2 mg/dL and urinary output of 350

mL over the past 6 hours. Which approach would be

best for this patient’s initial treatment?

and conservative fluid management.

management.

management.

management.