35-year-old female, three weeks in ICU post re-do MVR with peri-operative multi-organ failure, complicated post-operative course and slow ventilatory wean. Background included ESRF on dialysis. Findings on examination included tracheostomy, high sputum load, old ICC site, small tidal volumes on moderate level of pressure support ventilation, low vasopressor requirement, prosthetic heart valve, signs of right heart failure, general deconditioning and global weakness, presence of AV fistula in left forearm, and evidence of melaena in faecal management system.
Candidates were directed to identify the major issues with a plan for their management. Discussion points included causes of failure to progress.