FFICM Clinical Standards and Guidelines 3 — Questions and Answers
Question 1: Under the Mental Capacity Act 2005 (England and Wales), when a critically ill patient lacks capacity, treatment decisions must be made in whose best interests?
- The next of kin, who has legal authority to consent
- The senior consultant alone
- The patient, based on all available evidence of their values and wishes (Correct answer)
- The hospital ethics committee
Correct answer: The patient, based on all available evidence of their values and wishes
The MCA requires best-interests decisions centred on the patient's own values, wishes, and feelings — next of kin are consultees, not legal decision-makers.
Question 2: The BTS/ICS guidelines on weaning from mechanical ventilation recommend that a spontaneous breathing trial (SBT) be attempted when FiO₂ is at or below what level?
- 0.3
- 0.4 (Correct answer)
- 0.5
- 0.6
Correct answer: 0.4
BTS/ICS weaning guidelines recommend SBT assessment when FiO₂ ≤ 0.4 (with PEEP ≤ 8 cmH₂O and adequate respiratory drive).
Question 3: Which international guideline specifically recommends against routine use of pulmonary artery catheters (PAC) in general ICU management due to lack of mortality benefit?
- Surviving Sepsis Campaign 2021
- NICE guideline CG50 (acutely ill adults)
- ESICM PAC consensus statement
- Both A and C (Correct answer)
Correct answer: Both A and C
Both the SSC 2021 and ESICM consensus agree that routine PAC use does not improve outcomes and recommend against it as standard practice.
Question 4: According to FICM/ICS guidelines on organ donation, a 'Specialist Nurse for Organ Donation' (SNOD) should be involved at what stage of the end-of-life process?
- Only after the family has agreed to donation
- After death is confirmed
- Early, alongside end-of-life discussions, before family approach (Correct answer)
- Only in DCD cases, not DBD
Correct answer: Early, alongside end-of-life discussions, before family approach
FICM/NHSBT guidelines recommend early SNOD involvement to facilitate optimal family communication and maximise donation opportunities.
Question 5: The ARDS Network low tidal volume strategy uses a target tidal volume based on which measurement?
- Actual body weight
- Ideal body weight (IBW) (Correct answer)
- Lean body mass
- Measured functional residual capacity
Correct answer: Ideal body weight (IBW)
The ARDSNet protocol targets 6 mL/kg of ideal body weight to limit ventilator-induced lung injury regardless of actual weight.
Question 6: Which NICE guideline covers the management of sepsis in adults and recommends starting IV antibiotics within how many minutes of recognising sepsis?
- 30 minutes
- 60 minutes (Correct answer)
- 90 minutes
- 120 minutes
Correct answer: 60 minutes
NICE NG51 (Sepsis) recommends IV antibiotics within 1 hour of recognition for adults with suspected sepsis and organ dysfunction.
Question 7: The 2021 ESPEN guidelines on nutrition in ICU recommend initiating enteral nutrition within what timeframe for haemodynamically stable ICU patients?
- Within 6 hours
- Within 24–48 hours (Correct answer)
- Within 72 hours
- Only after gastric residual volumes are confirmed <200 mL
Correct answer: Within 24–48 hours
ESPEN 2021 recommends early enteral nutrition within 24–48 hours in haemodynamically stable ICU patients to preserve gut barrier function.
FFICM Clinical Standards and Guidelines 3
Under the Mental Capacity Act 2005 (England and Wales), when a critically ill patient lacks capacity, treatment decisions must be made in whose best interests?