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.