A 65-year-old woman with a history of hypertension and type 2 diabetes is admitted to the ICU with septic shock secondary to pneumonia. Despite aggressive fluid resuscitation, she remains hypotensive and is receiving norepinephrine at 0.3 mcg/kg/min. Her mean arterial pressure is 65 mm Hg, heart rate 115 beats/min, and lactate is 4.2 mmol/L. A bedside echocardiogram reveals a left ventricular ejection fraction of 30% and a calculated cardiac index of 1.8 L/min/m2. Mixed venous oxygen saturation is 58%. Which of the following is the most appropriate next agent to add?

A 35-year-old man with severe asthma is intubated and placed on assist-control mechanical ventilation for status asthmaticus. His ventilator settings are tidal volume 6 mL/kg, respiratory rate 20 breaths/min, inspiratory flow 60 L/min (I:E ratio 1:1), PEEP 5 cm H₂O. Measured peak inspiratory pressure is 45 cm H₂O, and intrinsic PEEP (auto-PEEP) is 15 cm H₂O. He is hypotensive (85/50 mmHg) with a central venous pressure of 18 mm Hg. Waveforms show a prolonged expiratory phase despite inhaled bronchodilators and IV corticosteroids. Which pathophysiological mechanism is MOST directly responsible for the elevated intrinsic PEEP and impaired venous return?

A 28-year-old woman with known moderate persistent asthma presents to the emergency department with worsening dyspnea and wheezing despite her home inhaled corticosteroid regimen. Over the past 30 minutes in the ED she has received three albuterol nebulizer treatments and one dose of ipratropium without improvement. On examination, she is agitated, speaks only 1–2 words per breath, and uses accessory muscles. Vital signs: heart rate 135 bpm, respiratory rate 38 breaths/min, SpO₂ 88% on 100% FiO₂ via nonrebreather. Arterial blood gas on FiO₂ 100% shows pH 7.30, PaCO₂ 52 mmHg, PaO₂ 60 mmHg. Auscultation reveals markedly diminished breath sounds bilaterally. Based on these findings, which combination is MOST indicative of a life-threatening (near-fatal) asthma exacerbation requiring urgent ICU escalation?

An adult patient is admitted to the ICU with a severe asthma exacerbation. She has had multiple prior hospitalizations for asthma and reports “stretching out” her inhaled controller medication because of cost. As the critical care pharmacist, which social determinant of health is the highest priority to assess and address to reduce her risk of future life-threatening asthma episodes?

A 68-year-old man is admitted to the ICU with septic shock secondary to pneumonia. After receiving 30 mL/kg of crystalloid and initiation of norepinephrine at 0.1 μg/kg/min, his mean arterial pressure remains 60 mm Hg. Transthoracic echocardiography shows a reduced ejection fraction of 35% with elevated left ventricular end-diastolic pressure, indicating septic cardiomyopathy. According to the 2021 Surviving Sepsis Campaign guidelines, which adjunctive agent is most appropriate to improve cardiac output in this patient?

A 28-year-old woman with a history of asthma is admitted to the ICU with acute respiratory distress. She is speaking in single words, using marked accessory muscles to breathe, and appears agitated. Her oxygen saturation on room air is 88%. Arterial blood gas reveals a PaCO2 of 58 mmHg and a PaO2 of 55 mmHg. On auscultation, breath sounds are markedly diminished. Based on the patient’s clinical presentation and objective measures, what is the MOST appropriate classification for this asthma exacerbation according to GINA 2024 guidelines?

A 28-year-old man with a history of severe asthma is admitted to the ICU for a life-threatening asthma exacerbation requiring mechanical ventilation. Initial arterial blood gas (ABG) showed a pH of 7.48, PaCO₂ of 30 mmHg, and PaO₂ of 75 mmHg on 60% FiO₂. After 2 hours, repeat ABG reveals a pH of 7.32, PaCO₂ of 48 mmHg, and PaO₂ of 55 mmHg despite ongoing ventilatory support. The patient is tachypneic with visible accessory muscle use and remains hypoxemic. Which of the following is the MOST critical immediate action a critical care pharmacist should recommend to the medical team to prevent further respiratory deterioration?

A 45-year-old patient on assist-control mechanical ventilation for a severe asthma exacerbation suddenly develops hypotension and a marked rise in peak airway pressures during evening rounds. Given this acute deterioration, which diagnostic modality is MOST appropriate for rapid bedside evaluation to identify a potentially life-threatening complication?

A 45-year-old female with a history of severe asthma is admitted to the ICU for status asthmaticus. She is intubated and mechanically ventilated due to respiratory failure. Despite receiving intermittent nebulized albuterol treatments, her bronchospasm persists with poor clinical improvement. High-dose systemic corticosteroids have already been initiated. The ICU team seeks to optimize bronchodilation to improve airway patency. Which of the following initial pharmacotherapy regimens is MOST appropriate to maximize bronchodilation in this critically ill patient?

A 35-year-old woman (70 kg) with severe persistent asthma is admitted to the ICU, intubated and mechanically ventilated for status asthmaticus refractory to continuous albuterol nebulization and magnesium sulfate infusion. Oral administration is contraindicated. Current guidelines recommend approximately 5 days of systemic corticosteroids in this setting. Which of the following IV corticosteroid regimens is most appropriate to control her airway inflammation?