Critical Care Medicine: Principles of Critical Care

Question · easy

A 63-year-old man is admitted to the ICU with septic shock and is stabilized on low-dose vasopressors. He has a functioning gastrointestinal tract. What is the recommended approach to nutritional support?

Start enteral nutrition within 24 to 48 hours of admission Withhold feeding until vasopressors are discontinued Wait for return of bowel sounds before initiating any feeding Start parenteral nutrition immediately to meet full caloric goals

Question · easy

A mechanically ventilated ICU patient requires continuous sedation. According to guideline-based practice, which agents are preferred over benzodiazepines?

Haloperidol scheduled every 6 hours Propofol or dexmedetomidine Ketamine infusion as monotherapy Midazolam or lorazepam

Question · medium

The AID-ICU trial randomized approximately 3,400 mechanically ventilated ICU adults to dexmedetomidine-based sedation versus usual care (mostly propofol). Which result is correct?

No difference in 90-day mortality, with more bradycardia and hypotension on dexmedetomidine Higher 90-day mortality with dexmedetomidine due to excess agitation Significant reduction in time to extubation with dexmedetomidine Significant reduction in 90-day mortality with dexmedetomidine

Question · medium

A nonmalnourished, mechanically ventilated patient is receiving enteral nutrition but has achieved only 40% of energy and protein goals by day 5. What is the most appropriate nutritional management?

Increase enteral rate to reach full caloric goals within 24 hours Add supplemental parenteral nutrition immediately Continue enteral nutrition alone for now Replace enteral with full parenteral nutrition

Question · hard

An ICU team considers pharmacologic prophylaxis to prevent delirium in a high-risk, mechanically ventilated patient. Which statement best reflects current evidence?

Scheduled haloperidol reduces delirium duration and mortality No medication prevents or treats ICU delirium; prevention is nonpharmacologic, and benzodiazepines are reserved for alcohol withdrawal or seizures Quetiapine shortens delirium duration and should be started prophylactically Prophylactic dexmedetomidine is recommended to prevent delirium in all ventilated patients

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