Multisystem Failure And Prognosis Practice Test

A 55-year-old woman with alcoholic cirrhosis (MELD score 25) is admitted to the ICU for septic shock from spontaneous bacterial peritonitis. She is intubated for airway protection due to grade III hepatic encephalopathy. Despite broad-spectrum antibiotics and vasopressor support with norepinephrine, her mean arterial pressure remains 55 mmHg, lactate is 7.2 mmol/L, and creatinine is 2.9 mg/dL. The family wishes to pursue all aggressive measures.

A 70-year-old man is in the ICU for 14 days with ARDS secondary to influenza pneumonia. He remains dependent on the ventilator but is hemodynamically stable and off vasopressors. He is awake and follows commands but is too weak to participate in spontaneous breathing trials. The team is considering a tracheostomy. The family is concerned this means he will never get better.