Critical Care Medicine Hemodynamic Monitoring: Review Questions Steven Lin, MD, and John M. Oropello, MD, FCCP, FCCM Dr. Lin is a fellow in critical care medicine, and Dr. Oropello is program director of critical care medicine and an associate professor of surgery and medicine; both are at Mount Sinai School of Medicine, New York, NY. Choose the single best answer for each question.
	1. A 44-year-old man with hypertension and diabetes is admitted to the intensive care unit (ICU) for severe pancreatitis. Soon thereafter, he develops respiratory distress requiring intubation. His blood pressure is 80/30 mm Hg, heart rate is 120 bpm, and respiratory rate is 24 breaths/min. His serum creatinine level is 2.5 mg/dL (baseline, 1.0 mg/dL), and his arterial lactate level is 3.8 mg/dL. An electrocardiogram shows sinus tachycardia with occasional ventricular premature beats, and chest radiograph shows bilateral fluffy infiltrates. The ventilator is set on assist-control mode; tidal volume, 500 mL; respiratory rate, 12 breaths/min, Fio2, 100%; and positive end-expiratory pressure, 10 cm H2O. Pulse oximetry shows Sao2 of 90%. Data from a pulmonary artery catheter (PAC) show central venous pressure (CVP), 24 mm Hg; pulmonary artery pressure, 35/20 mm Hg; pulmonary artery wedge pressure (PAWP), 12 mm Hg; and cardiac output (CO), 4.5 L/min. At this point, what is the best management option for this patient? Intravenous (IV) furosemide 40 mg IV ß-blockers IV amiodarone IV fluid bolus IV dobutamine Click here to compare your answer. 2. A 58-year-old man with liver failure from hepatitis C cirrhosis is admitted to the surgical ICU after liver transplantation. The patient is intubated and has a perioperatively placed PAC. He is 5 ft 8 in, weighs 78 kg, and his vital signs are: blood pressure, 98/50 mm Hg; mean arterial pressure, 66 mm Hg; heart rate, 108 bpm; and temperature, 36°C. Results of laboratory tests show: leukocyte count, 12.0 × 103/mm3; hemoglobin level, 9.0 g/dL; international normalized ratio, 2.3; arterial lactate level, 5 mg/dL (increased from 3.4 mg/dL immediately postoperatively); sodium, 134 mEq/L; potassium,		4.5 mEq/L; bicarbonate, 23 mEq/L; blood urea nitrogen, 20 mg/dL; creatinine, 1.4 mg/dL; and glucose, 123 mg/dL. Results of an arterial blood gas sampling show: pH, 7.36; Pco2, 38 mm Hg; Po2, 120 mm Hg; and Sao2, 95%. Results of mixed venous blood gases show: pH, 7.32; Pco2, 50 mm Hg; Po2, 43 mm Hg; and Svo2, 72%. PAC data are: CVP, 8 mm Hg; PAWP, 12 mm Hg; CO, 4.0 L/min; and systemic vascular resistance, dynes/sec/cm-5. Which of the following statements regarding this patient’s CO is correct? CO is adequate CO is not adequate CO is too high CO is falsely low CO cannot be accurately determined in transplant patients Click here to compare your answer. 3. To clarify the utility of the PAC to improve patient outcome, several major studies have been conducted. These studies have demonstrated which of the following? Perioperative PAC use benefits high-risk surgical patients PAC use does not benefit patients with acute respiratory distress syndrome (ARDS) PAC use harms patients with septic shock PAC use should not be allowed in the ICU setting PAC use benefits patients with septic shock Click here to compare your answer.
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