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4.    Management of patients in shock requiring hemodynamic monitoring and vasopressors. The PAs inserted central lines and assisted the physician in floating Swan-Ganz catheters. They wrote orders for fluid resuscitation and vasoactive medications after consultation with the physician. They also analyzed hemodynamic data and initiated changes in therapy accordingly. 5.    Reversal of life-threatening episodes of arrhythmia. The PAs administered antiarrhythmic medications in accordance with protocols developed in our unit. Following that, immediate consultation with the physician was obtained. 6.    The task of weaning patients from mechanical ventilation was performed jointly by the physician, who set the global plan (mode of ventilation, oxygen concentration, pressure support, etc) and the PA who periodically followed the patient’s progress, made fine adjustments, checked the patient clinically, measured arterial blood gas values or transcutaneous oxygen saturation, or both, and reported changes to the physician for final approval or modification. 7.    Performance of invasive procedures including insertion of arterial lines, central venous catheters, pleural taps, peritoneocentesis, lumbar puncture and others under direct supervision. In this case, physician supervision meant the actual presence of the physician inside the intensive care unit. In other situations, such as writing orders or initiating therapy, the ability of the PA to communicate via telephone with a physician who is physically in the building but not necessarily in the intensive care unit was considered sufficient supervision.