A 58 year old man is admitted to the Intensive Care Unit, intubated and ventilated. Haemodynamic monitors have been inserted and the following haemodynamic measurements have been recorded:
Mean arterial pressure 53 mmHg
Central venous pressure 15 mmHg
Cardiac output 6.8 L/min
[Cardiac index 3.8 L/min/m2]
1. Describe this circulatory disturbance.
The rest of the questions focused on the rational approach to uses of inotropes and vasopressor including a discussion of some of the recent evidence.
Mr Gere, a previously well 47 yo male, has been admitted to the ICU for 5 days with severe sepsis secondary to a perforated sigmoid colon. He had a sigmoid colectomy and washout of his peritoneum, and appropriate antibiotic therapy. His initial course was complicated by severe septic shock and multi-organ failure that is now resolving. He is currently ventilated via an oral endotracheal tube, on SIMV with a rate of 16, TV of 700 ml, PEEP of 5 cm H2O and FIO2 of 0.45. He is receiving a small dose of fentanyl and propofol, but is awake and co-operative although he has generalised weakness. His arterial blood gas result is shown below: