Challenge #11

A 46-year-old woman is admitted with pneumococcal pneumonia and has a background of hypertension. She is now failing to wean from mechanical ventilation, with worsening acute pulmonary oedema (APO) and escalating vasopressor requirements.
She is receiving dobutamine at 5 mcg/kg/min and noradrenaline at 0.2 mcg/kg/min, with a mean arterial pressure (MAP) of 55 mmHg.