A 45-year-old previously healthy female presents to the emer…

A 45-year-old previously healthy female presents to the emergency department with 3 days of fevers and progressive dyspnea and is admitted to the intensive care unit (ICU) for influenza infection complicated by severe hypoxemia. She is intubated, and chest radiograph following intubation demonstrates an appropriately placed endotracheal tube with bilateral patchy opacities and interstitial markings throughout all lung fields, without effusions. Her bedside echocardiogram reveals a left ventricular ejection fraction of 0.75 with otherwise normal findings. Her ventilator settings are volume control, tidal volume (VT) 500 mL, respiratory rate (RR) 14 breaths per minute, FiO2 1.0, and positive end-expiratory pressure (PEEP) 5 cm H2O. An initial arterial blood gas (ABG) is pH 7.30 PCO2 45 mm Hg and PO2 80 mm Hg. Which of the following therapies has been best shown to improve the survival of patients such as this woman?

Broker Brenda with Aloha Realty is working with George on a…

Broker Brenda with Aloha Realty is working with George on a customer basis. She shows him numerous properties in the area and price range George indicated he wished to see. George has decided to make an offer on a property. Which remark by Brenda would NOT be appropriate considering her sub agency relationship with the seller?

A 65-year-old female with a history of severe COPD and coron…

A 65-year-old female with a history of severe COPD and coronary artery disease is intubated for severe acute respiratory distress syndrome (ARDS) in the setting of pneumonia. Despite ventilation with 6 mL/kg tidal volumes and neuromuscular blockade, PaO2:FiO2 remains 85 on FiO2 100%. PEEP is increased from 5 to 10 cm H2O, and mean arterial pressure subsequently decreases from 65 to 45. In what setting is increased PEEP least likely to improve oxygenation and hemodynamics?