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539 Anaesthesia

A 55-year-old woman was admitted to the intensive care unit with severe lobar pneumonia and septic shock. She remained hypoxemic despite intubation, a high fraction of inspired oxygen, and positive end-expiratory pressure (PEEP). When PEEP was increased further, she paradoxically became more hypoxemic and her blood pressure and central venous hemoglobin saturation fell. What would be your approach

AKeep PEEP at the highest and give adrenaline
BInitiate dobutamine and reduce PEEP to 5cm H2O
CIncrease PEEP further
DIncrease FiO2
Anaesthesia
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