ICU Vivas · Resuscitation
Goals of care in deteriorating septic shock
A CICM communication viva — the candidate must break difficult news, convey an honest prognosis, explore the patient's values, and align the level of treatment with the patient's goals, using a structured framework and empathic technique.
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Mr P, 74, was admitted three days ago with septic shock from a perforated viscus. He has had surgery and source control, maximal vasopressor and respiratory support, and continuous renal replacement therapy, but his lactate is rising again and his pressor requirements are climbing. He has metastatic prostate cancer and pre-existing cardiac failure. The team feels further escalation (for example, a second vasopressor and re-operation) may not be in his interests. His daughter has arrived and is asking, "Is Dad going to be alright?"
Take the chair opposite the examiner (role-playing the daughter) and conduct the conversation.[3]
References3ShowHide
- [1]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Medicine, 2021.PMID 34599691
- [2]Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016.PMID 26903338
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.