Crème de la Misc: essential reading for random topics

Because CICM have historically asked written questions an impressively diverse range of miscellaneous topics, and then basically never repeated them, the trainee is somewhat adrift with regards to what might be expected from them in the future. What follows is an attempt to use the experience of the past to predict future examiner behaviour, and arm the exam candidates with some basic tools to help them revise in preparation for the unpredictable. Wherever overlap exists between these topics and other chapters, links are used to redirect the reader and keep the length of this inventory to a manageable minimum.

Trials and guidelines on ICU "housekeeping"

Protocolised bundles of supportive care in general

  • CHECKLIST-ICU - 2016 - daily checklist and goal setting bundle; n=6877 in Brazil. No difference in mortality ((32.9% vs 34.8%) but a few secondary outcomes were better (use of low tidal volumes, avoidance of heavy sedation, use of central venous catheters, use of urinary catheters, perception of team work, and perception of patient safety climate)
  • 2018 SCCM guidelines on, basically, FASTHUG

Nutrition trials and guidelines

Analgesia and sedation

Thromboprophylaxis trials and guidelines

Patient mobility and positioning 

Physiotherapy for the critically ill

Pressure area prevention

Ulcer prophylaxis

Glycaemic control in the ICU

Physical examination findings

CICM have asked a lot of weird questions in the past, for example about the non-cardiorespiratory causes of cyanosis, or how to tell the difference between a kidney and a spleen using nothing but the crude sensitivity of your fingers (like you'd make a surgical referral on the basis of those findings). Most of these questions appear to have come from the pre-2010 exam, which helps delineate the year in which the examiner who insisted on them had retired. A system of checks and balances in exam design has since replaced the lawlessness of those earlier papers, but just in case, it would not hurt to be familiar with the content of Talley & O'Connor's Clinical Examination of whatever second-hand edition, as this is likely to have the highest yield in terms of mark density per gram of printed paper. Those morally above resorting to online piracy may be able to score a cheap copy from a final-year medical student about to embark on a career in pathology.

Radiology and ultrasound

Transport of the critically ill patient

Frailty, ageing, and functional outcomes in critical care

Rare or multisystem diseases in the CICM Part II exam

Rheumatological, systemic autoimmune and generally congenital conditions which have appeared in the exam have included rheumatoid arthritissystemic sclerosisDown syndrome, myotonic dystrophy, acromegaly, ankylosing spondylitis, Parkinson's disease, and SLE. The questions on these have generally consisted of "outline" and "discuss" style questions about how these diseases influence the care of the patient who has them, who ends up in the ICU for whatever reason. Obviously, trainees cannot protect themselves from such questions in the future with revision, as the range of possible conditions is vast, and repeated SAQs are unpredictable. Instead it is recommended that they adopt and practice a systems-based structure which might help them construct and answer with some headings, and hopefully help recall vague snippets of information about a half-forgotten systemic weirdopathy. One such system could be:

  • A - airway issues and concerns about intubation (or prognosis-related concerns about offering intubation or tracheostomy)
  • B - lung involvement, weaning, pulmonary circulatory problems
  • C - and acquired or congenital cardiac problems, and  peripheral circulatory problems (including any issues with vascular access)
  • D - neurological involvement, neuromuscular problems
  • E - tendency towards specific endocrine electrolyte derangement (whether due to the condition or due to the treatment for it, such as steroids)
  • F - renal involvement which could be also genitourinary
  • G - Gastrointestinal, hepatic or metabolic/nutritional problems, including things like difficulty placing NG tubes into uncooperative intellectually disabled patients
  • H - haematological and bone-marrow-related considerations, including the consequences of therapy (eg. bone marrow suppression)
  • I - immunological and infectious complications (including things like impaired wound healing or immunosuppressive therapy)
  • K - knowledge gaps which call for superspecialised investigations,  consultations or cultural advice
  • L - the need to discuss the prognosis with loved ones (as often these conditions may culminate in a protracted course of ICU stay)

This is obviously not the only possible system and the author of it is acutely conscious of the fact that he is not an expert and anyway writing these notes at 3am, which places him in a uniquely stupid position. Trainees are advised to generate their own systems and compare with each other to improve them.

Critical care dermatology - this covers the narrow overlap between dermatology and intensive care that can broadly be described as "things were your skin is falling off". There is obviously no way to rapidly become an expert in such things for the CICM fellowship exam. The best thing one can do is get a good review such as Badia et al (2020)


Cavalcanti, Alexandre B., et al. "Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients: a randomized clinical trial." Jama 315.14 (2016): 1480-1490.

Devlin, John W., et al. "Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU." Critical care medicine 46.9 (2018): e825-e873.

Schünemann, Holger J., et al. "American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients." Blood advances 2.22 (2018): 3198-3225.

Lerma, F. Álvarez, et al. "Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish “Zero-VAP” bundle." Medicina intensiva 38.4 (2014): 226-236.

Muscedere, John, et al. "Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention.Journal of critical care 23.1 (2008): 126-137.

Bein, Th, et al. "S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders: revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI)." Der Anaesthesist 64 (2015): 1.

Aquim, Esperidião Elias, et al. "Brazilian guidelines for early mobilization in intensive care unit." Revista Brasileira de terapia intensiva 31 (2020): 434-443.

Lang, Jenna K., et al. "Clinical practice guidelines for early mobilization in the ICU: a systematic review." Critical Care Medicine 48.11 (2020): e1121-e1128.

Sommers, Juultje, et al. "Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations." Clinical rehabilitation 29.11 (2015): 1051-1063.

Gosselink, Rik, et al. "Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on physiotherapy for critically ill patients." Intensive care medicine 34 (2008): 1188-1199.

Ye, Zhikang, et al. "Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline." Bmj 368 (2020).

American Diabetes Association. "13. Diabetes care in the hospital." Diabetes Care 39.Supplement_1 (2016): S99-S104.

Australian Diabetes Society. "Guidelines for routine glucose control in hospital." Australian Diabetes Society (2012).

Lovegrove, Josephine, Paul Fulbrook, and Sandra Miles. "International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study." International Wound Journal 17.5 (2020): 1112-1127.

Mendes, João João, et al. "Sociedade Portuguesa de Cuidados Intensivos guidelines for stress ulcer prophylaxis in the intensive care unit." Revista Brasileira de terapia intensiva 31 (2019): 5-14.

Ichai, Carole, and Jean-Charles Preiser. "International recommendations for glucose control in adult non diabetic critically ill patients." Critical Care 14.5 (2010): 1-11.

Laroia, Archana T., et al. "ACR appropriateness Criteria® intensive care unit patients." Journal of the American College of Radiology 18.5 (2021): S62-S72.

Dent, E., et al. "Physical frailty: ICFSR international clinical practice guidelines for identification and management." The journal of nutrition, health & aging 23 (2019): 771-787.

Dent, Elsa, et al. "The Asia-Pacific clinical practice guidelines for the management of frailty." Journal of the American Medical Directors Association 18.7 (2017): 564-575.

Badia, Mariona, et al. "Dermatological manifestations in the intensive care unit: A practical approach." Critical Care Research and Practice 2020 (2020).