A 68-year-old man with severe chronic obstructive pulmonary disease (COPD) is admitted to the intensive care unit for a severe acute exacerbation requiring endotracheal intubation and mechanical ventilation. He remains in acute respiratory distress with wheezing and increased work of breathing despite systemic corticosteroids and oxygen therapy. The ICU team plans to initiate inhaled bronchodilator therapy. Considering his intubated status and the severity of his exacerbation, which of the following inhaled bronchodilator regimens is most appropriate to prioritize?

A 68-year-old male with severe COPD is intubated and on mechanical ventilation in the ICU due to acute hypercapnic respiratory failure. He is receiving low-dose norepinephrine for mild hypotension. Peak inspiratory pressures are elevated at 38 cmH2O, with persistent wheezing and prolonged expiratory phase. Arterial blood gas reveals pH 7.28, PaCO₂ 65 mmHg, PaO₂ 88 mmHg, HCO₃ 28 mEq/L. The clinical team requests recommendations to optimize inhaled bronchodilator therapy via the ventilator circuit. Which of the following is the MOST appropriate initial inhaled bronchodilator regimen?

A 68-year-old man with severe chronic obstructive pulmonary disease (COPD) is admitted to the intensive care unit (ICU) with acute hypercapnic respiratory failure requiring assist-control mechanical ventilation and low-dose norepinephrine for blood pressure support. He has a 3-day history of worsening dyspnea, productive green sputum, leukocytosis, and elevated inflammatory markers, and the medical team is initiating broad-spectrum antibiotics. Which systemic corticosteroid regimen is most appropriate, according to current GOLD 2024 recommendations (Grade A), to reduce airway inflammation and lower treatment failure risk in this ICU patient with an acute COPD exacerbation?

A 65-year-old man with severe COPD (FEV₁ 25% predicted) was admitted to the ICU 2 days ago for acute hypercapnic respiratory failure requiring mechanical ventilation. He has had two antibiotic-treated COPD exacerbations in the past 6 months. Today he develops fever (38.5 °C), worsening dyspnea, increased volume and purulence of sputum, and a white blood cell count of 16,000/mm³ with neutrophilia. A sputum Gram stain shows numerous white blood cells and Gram-negative rods. No prior multiresistant organisms have been isolated. Which empiric antibiotic regimen is most appropriate to initiate?

A 68-year-old man with severe COPD on home oxygen is admitted with an acute exacerbation characterized by increased dyspnea, sputum volume, and purulence. He required intubation and mechanical ventilation within 24 hours of admission. He has no history of Pseudomonas colonization, bronchiectasis, or recent hospitalizations, and there is no suspicion for ventilator-associated pneumonia. According to GOLD 2024 guideline recommendations, which empiric antibiotic regimen and duration is most appropriate for this patient?

A 65-year-old man with a history of severe COPD was admitted to the ICU for a severe exacerbation requiring intubation and mechanical ventilation. After 5 days of IV corticosteroids and continuous nebulized albuterol/ipratropium, he has been extubated, is clinically stable, and tolerating oral intake. You are asked to recommend the next step in his pharmacotherapy as he transitions out of ICU-level care. Which of the following is the MOST appropriate pharmacotherapy transition plan for this patient?

A 68-year-old man with a history of chronic obstructive pulmonary disease (COPD) complicated by cor pulmonale is admitted to the ICU for an acute COPD exacerbation. He is hemodynamically stable but has signs of volume overload, including 3+ pitting edema, elevated jugular venous pressure, bilateral crackles, and oliguria over the past 12 hours. Vital signs are within normal limits and there is no evidence of acute infection. Which of the following pharmacotherapy interventions is MOST appropriate to prioritize for managing his current volume status?

A 68-year-old man with severe COPD complicated by cor pulmonale is admitted to the ICU with an acute exacerbation characterized by worsening dyspnea, increased sputum production, and systemic signs of volume overload (3+ pitting lower extremity edema, jugular venous distension to the angle of the jaw, and diffuse crackles on lung auscultation). He is intubated and receiving mechanical ventilation. Vital signs are stable (BP 128/78 mmHg, HR 88 bpm, SpO₂ 92% on FiO₂ 0.4). His renal function is at baseline. He is not on any home diuretic therapy. An echocardiogram from 3 months ago demonstrated severe pulmonary hypertension with moderate right ventricular dysfunction. Which pharmacotherapeutic intervention should be prioritized to manage his volume overload and optimize respiratory mechanics?

A 68-year-old man with septic shock requiring norepinephrine infusion has been mechanically ventilated for 36 hours and is expected to require ventilation for more than 48 hours. His platelet count and INR are within normal limits. Which of the following is the most appropriate pharmacotherapy plan for stress ulcer prophylaxis?

A 72-year-old male is admitted to the ICU following an acute exacerbation of chronic obstructive pulmonary disease. He has been on assist-control mechanical ventilation for 72 hours, is receiving vasopressors via a central venous catheter, and has an INR of 2.8 with a platelet count of 180,000/mm3. He is tolerating continuous enteral nutrition via a nasogastric tube at 40 mL/hour. Considering his risk factors for stress-related mucosal bleeding, which pharmacologic strategy is most appropriate for stress ulcer prophylaxis?