A 65 year old male with a past history of ischaemic heart disease is admitted to the ICU after a motorcycle crash having sustained long bone fractures of the lower limbs. He has no head, chest or abdominal injuries. Prior to surgery, his GCS was 15 and SpO2 was 98% on 4l oxygen via Hudson mask with a normal chest X-Ray. He required prolonged operative fixation of his fractures and that was complicated by significant blood loss. Intra-operatively, he also developed increasing oxygen requirement. On arrival in ICU, his most recent ABG on an FiO2 of 0.7 shows a PaO2 55 mmHg.
Q1: What are the possible differential diagnoses for his respiratory failure?
The rest of the viva focussed on progressing to TRALI related respiratory failure, pathogenesis of
TRALI and other complications of blood transfusion- storage lesions and infections.
Areas of weakness identified by examiners:
° Very few candidates could clearly articulate the diagnostic criteria and the mechanisms of TRALI
° Candidates also had difficulty in outlining the storage lesions.
Disclaimer: the viva stem above is the original CICM stem, acquired from their publicly available past papers. However, because the college do not make the rest of the viva text or marking criteria available, the rest has been confabulated. It sounds like a plausible viva and it can be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.