On admission of Patient A to the intensive care unit (ICU), the placement of the tracheal tube would be checked and pressure control ventilation would be begun with an inspiratory time 50%. A central venos catheter and arterial catheter would be inserted, low-dose epinephrine (less than 8 μg/min) would be started immediately, and preload would be assesed by echocardiography and by ascertaining the systolic pressure variation and noninvasive cardiac output, among other parameters. If preload was deemed high, positive end-expiratory pressure (PEEP) would be increased to 16 cm H2O to reduce preload and afterload and improve oxygenation. If preload was assesed to be low, fluid would be given in titrated boluses before PEEP was increased. If the blood pressure failed to improve, norepinephrine would be titrated to achieve a mean arterial pressure of at least 70 mm Hg.
KeywordsCatheter Urea Citrate Pneumonia Morphine
Unable to display preview. Download preview PDF.