ICU Vivas · Resuscitation
Data viva — a shock resuscitation dataset
A data-interpretation viva in which the candidate integrates the perfusion markers (lactate, capillary refill), the fluid-responsiveness test (pulse-pressure variation), and the cardiac output response, and decides whether to continue the fluid.
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Study tools
Target exams
CICMFFICMEDIC
Prompt
A bedside dataset from a patient in septic shock at baseline and after a fluid bolus — the MAP, the lactate, the capillary refill, the pulse-pressure variation and the cardiac output — to be interpreted.
Stimulus
You are shown the dataset of a ventilated patient in septic shock, before and after a 500 mL bolus of balanced crystalloid:
[3]| Time | MAP (mmHg) | Lactate (mmol/L) | Capillary refill (s) | ΔPP (%) | Cardiac output (L/min) |
|---|---|---|---|---|---|
| Baseline | 62 | 4.1 | 5 | 16 | 6.2 |
| After bolus | 68 | 3.0 | 3 | 9 | 8.4 |
Interpret the dataset.[2]
References4ShowHide
- [1]Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest, 2008.PMID 18628220
- [2]Michard F, Boussat S, Chemla D, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. American Journal of Respiratory and Critical Care Medicine, 2000.PMID 10903232
- [3]Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock (ANDROMEDA-SHOCK). JAMA, 2019.PMID 30772908
- [4]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.