Viva 5

A 51-year-old female with a 20 pack-year history of smoking is now day 10 in your ICU with community acquired pneumonia.

The bedside nurse calls you and describes increasing oxygen requirements over 15 minutes, high airway pressure alarms on the ventilator and persistently low oxygen saturations.

She is mechanically ventilated via an oral endotracheal tube with a moderate volume of sputum on suctioning, on volume controlled ventilation with the following parameters:

  • FiO2 0.80 Tidal volume (Vt) 400 mls
  • Respiratory rate 15 per min
  • PEEP 10 cmH2O
  • Peak airway pressure 35 cmH2O

Her ABG result shows pH 7.25, pCO2 60 mmHg, pO2 50 mmHg.

Describe your assessment and management.

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.