Critical Care Daily Review Note

Synopsis and Progress

• Day 3 ICU admission for 68-year-old male (MRN: 492-817-34) with severe community-acquired pneumonia and septic shock. Background of COPD and T2DM. Intubated in ED on 12/05/2026 due to type 1 respiratory failure; currently weaning vasopressors and ventilatory support.

• A - Oral ETT size 8.0, 22 cm at teeth, cuff pressure 25 cmH2O. Patent, minimal clear secretions on suction.

• B - Ventilated on PSV: PS 10 cmH2O, PEEP 8 cmH2O, FiO2 0.35. SpO2 95 %, RR 18 bpm, Vt 450 - 500 mL. Chest auscultation: coarse crepitations right base, improved air entry bilaterally. ABG (06:00): pH 7.38, PaCO2 42 mmHg, PaO2 78 mmHg, HCO3 24 mmol/L.

• C - Sinus rhythm, HR 82 bpm. BP 115/65 mmHg (MAP 82 mmHg) on norepinephrine (noradrenaline, Levophed®) 2 mcg/min IV infusion (weaned from 8 mcg/min). Lactate 1.4 mmol/L. Peripherally warm, CRT < 2 s.

• D - GCS 10T (E4, V1T, M5), RASS -1. Pupils equal and reactive 3 mm bilaterally. On fentanyl 20 mcg/h IV and propofol (Diprivan®) 50 mg/h IV.

• E - Skin intact, Braden score 14, regular 2-hourly pressure area care, air mattress in situ. - Na 138 mmol/L, K 4.1 mmol/L, Mg 0.85 mmol/L, PO4 1.10 mmol/L, Ca (corr) 2.25 mmol/L.

• F - 24-hour balance: +350 mL (In: 2,150 mL, Out: 1,800 mL). UO 50 - 70 mL/h via IDC. Maintenance compound sodium lactate (Hartmann's) at 40 mL/h IV. Urea 8.2 mmol/L, Cr 98 umol/L (baseline 85 umol/L), eGFR 68 mL/min/1.73m2.

• G - Abdomen soft, non-distended, bowel sounds present. NGT in situ, Nutrison® Protein Plus at 60 mL/h (target 75 mL/h), minimal aspirates. BO x 1 small paste yesterday; on docusate sodium/senna (Coloxyl with Senna®) 2 tabs NGT BD. LFTs: Bilirubin 14 umol/L, ALT 32 U/L, ALP 85 U/L, GGT 45 U/L, Albumin 28 g/L.

• H - Hb 104 g/L, WCC 13.5 x 10^9/L (down from 18.2), Plt 240 x 10^9/L. INR 1.1, APTT 32 s. No active bleeding, no transfusions required.

• I - Temp 37.2 °C (afebrile for 24 h). CRP 110 mg/L (down from 185 mg/L). Sputum culture (12/05/2026): Streptococcus pneumoniae (sensitive to penicillin). Blood cultures negative at 48 h. Currently Day 3 IV ceftriaxone 1 g IV daily and azithromycin 500 mg IV daily.

• L - Right IJV CVC (inserted 12/05/2026, Day 3) - dressing intact, site clean. Right radial arterial line (inserted 12/05/2026, Day 3) - good trace, site clean. IDC in situ. NGT in situ (confirmed on CXR).

FASTHUGS

• Feeding: Enteral feeding via NGT with Nutrison® Protein Plus at 60 mL/h, increasing to target 75 mL/h today as tolerated.

• Analgesia: Fentanyl 20 mcg/h IV infusion, paracetamol (Panadol®) 1 g NGT QID.

• Sedation: Propofol (Diprivan®) 50 mg/h IV infusion; targeting RASS 0 to -1 for spontaneous breathing trial.

• Thromboprophylaxis: Enoxaparin (Clexane®) 40 mg SC daily and sequential compression devices (SCDs) bilaterally.

• Head-up: Head of bed elevated to 30 degrees.

• Ulcer prophylaxis: Pantoprazole (Somac®) 40 mg IV daily.

• Glycaemic control: BSLs 6.5 - 9.2 mmol/L over 24 h. Actrapid® sliding scale SC PRN (not required in last 24 h).

PLAN:

• Wean propofol (Diprivan®) and assess for spontaneous breathing trial (SBT) with view to extubate today if successful
• Wean off norepinephrine (noradrenaline, Levophed®) infusion to maintain MAP >= 65 mmHg
• Cease IV maintenance fluids and increase NGT feeds to target 75 mL/h
• De-escalate antibiotics to benzylpenicillin 1.2 g IV Q6H as per sputum sensitivities; cease ceftriaxone and azithromycin
• Mobilise to sit on edge of bed with physiotherapy assistance
• Repeat EUC, FBC, CRP tomorrow morning (15/05/2026)