Viva 4

Scenario: A 22 year old girl had chemotherapy and bone marrow transplantation for leukaemia.. While waiting for marrow recovery she develops hypoxic respiratory failure requiring admission to your Intensive Care Unit and non-invasive ventilation by mask with an FiO2 of 1.0. The PaO2 improves initially but she remains dyspnoeic.

Over the next 24 hours she becomes progressively more hypoxic and exhausted, and is intubated.

She requires an FiO2 of 1.0 and PEEP of 15cm H2O to achieve a PaO2 of 54mm Hg. 

Her Chest X-Ray shows dense bilateral pulmonary infiltrates. 

She requires increasing doses of noradrenaline by infusion (to 50mg/min) and progresses to acute renal failure.

Your registrar asks you whether you think it is appropriate to continue active management.

Introductory question: What are the ethical principles of medical care that must be considered when decisions regarding the withdrawal of active medical treatment are being made?

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.