Viva 2

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:

pH

7.32

PaO2

85 mmHg

(11.3 Kpa)

PaCO2 
HCO3-

45 mmHg
18 mmol/L

(6 Kpa)
(24 - 32mmol/L)

BE

-4.9 mmol/L

(-2.0 to 2.0 mmol/L)

1. How will you assess whether Mr Gere is ready to be extubated?

The rest of the questions focused on the approach to weaning a ventilated critically ill patient including a discussion on the various modes of weaning , timing of tracheostomy etc.

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.