A previously well 27 year old woman has been admitted to ICU following an appendectomy for a perforated appendix. Her Pulse is 130/min, BP 65/30 despite six litres of crystalloid resuscitation. Her SpO2 is 90% on FIO2 of 0.7, PEEP 10 cm H2O, SIMV. A noradrenaline infusion is being drawn up.
Would you give steroids to this patient?
Focus of discussion: Evidence base for using steroids in sepsis and other critical care illnesses – ARDS, TBI, Spinal injury
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.