Dazhong Net·Poster News reporter Xu Ling correspondent Ren Tiantian reported from Jinan
For 25-year-old Ms. Liu, many years later, recalling the Spring Festival of the Year of the Tiger in 2022, It must be an unforgettable experience. She ushered in a new year in the Department of Critical Care Medicine of Jinan Central Hospital, and also ushered in the hope of rebirth.
At the end of January 2022, one evening near the Spring Festival, Ms. Liu came to the fever clinic of the Central Hospital for treatment. In the past week, Ms. Liu developed symptoms of cough and sputum. At first, she thought it was a common cold and would be cured soon. However, she did not want her condition to get worse and worse, with symptoms such as difficulty breathing, palpitations, and chest tightness. , and had a fever, so I rushed to the hospital for treatment. After arriving at the hospital for examination, she found that Ms. Liu’s pulse oxygen saturation was only 45% (reference value 95-100%), less than half of the normal value, and her condition was severe to the point of respiratory failure. Lung CT showed pneumonia in both lungs, right lung Blockbuster real change. The fever clinic actively gave non-invasive ventilator treatment, and invited the on-duty doctor Cao Chongfeng, the deputy chief physician of the intensive medicine department, for consultation. Director Cao believed that Ms. Liu met the admission standards of the intensive medicine department. After the new crown nucleic acid test was negative, she was immediately admitted to the ICU for treatment.
After admission, Ms. Liu’s condition continued to worsen, and soon the non-invasive ventilator could not correct the hypoxic condition. The patient’s heart rate reached 140 beats/min, and she gradually became conscious. Fuzzy, Director Cao Chongfeng made a decisive decision and immediately gave bedside tracheal intubation and invasive mechanical ventilation. The possible pathogens of Ms. Liu’s severe pneumonia were comprehensively analyzed, corresponding anti-infective treatment was given, and etiological examinations were kept. Ms. Liu’s hypoxia was temporarily improved. On the second day after admission, Ms. Liu’s condition continued to deteriorate, the oxygenation index gradually decreased, and the oxygen concentration of the ventilator gradually increased to 100%. The prone position ventilation was given to improve oxygen and condition, but the effect was still poor. After ICU director Si Min, chief physician, organized department members to analyze and discuss the condition. Ms. Liu’s ventilator support has no room for adjustment, and the prone position ventilation is not effective, and the disease progresses rapidly. It is difficult to reverse the disease and continue to maintain the original treatment plan, and multiple organ failure caused by hypoxia will soon occur, and life may stop in seconds, but the patient also has advantages, young, healthy basic organ function, acute disease, and active treatment. There is a high possibility of recovery after treatment. After comprehensive analysis, Ms. Liu’s condition meets the indications for ECMO. After communicating with the patient’s family, she decided to give Ms. Liu V-VECMO treatment.
Time is life, a patient starts ECMO treatment one minute earlier, and the hope of survival increases by one point. The nurses in the intensive care department began to be busy and orderly. Preparing materials, pre-flushing pipelines… Under the unified coordination and command of Director Si Min, he is the chief physician of Tian Tian and Li Qiang, the deputy chief physician of CCU and ECMO team leader, Wang Lei, the chief physician of Cardiology Department, and the chief physician of vascular surgery. With the full support of the attending physician Wang Honglu, the patient was successfully put on the machine 15 hours after admission, and started the supportive treatment of ECMO. After getting on the plane, Ms. Liu’s hypoxia was completely relieved, her heart rate gradually dropped to normal from 150 beats/min before she got on the plane, and her vital signs became stable. At the same time, the support parameters of the ventilator were lowered accordingly, and lung protection ventilation was given. Strategies so that the affected lung can get adequate rest. ECMO provides valuable time for the treatment of the primary disease and plays a key role in reversing the disease.
After Ms. Liu’s hypoxic condition is relieved, the next treatment focus is on the treatment of the cause. Director Simin leads the doctors in the department to discuss the condition repeatedly, combining with the current season According to the characteristics of epidemiology, considering the possibility of infection by atypical pathogens such as mycoplasma, chlamydia, and influenza virus, corresponding anti-infective treatment should be given. Soon, the etiology results came out, showing that Ms. Liu suffered from mycoplasma pneumonia. According to the test results, the treatment plan was adjusted and the treatment was precise.
The successful rescue of a critically ill patient is inseparable from the close cooperation of the medical team. For a patient like Ms. Liu, whose life is on the line, not only the nursing staff have superb professional skills, but also the meticulous and humanized nursing service. The nursing team organized the backbone and provided professional and accurate nursing care in ECMO operation and maintenance, transport with machine, various operation cooperation, artificial airway management, nutritional support, etc. The comfort and care of Ms. Liu gradually got rid of the haze brought by death. During Ms. Liu’s entire treatment process, she received great efforts from CCU Director and ECMO Team Leader Wang Lei, Deputy Chief Physician, Respiratory Department Chief Physician Xing Chunyan, Wang Xin Deputy Chief Physician, Vascular Surgery Deputy Chief Physician Liu Zhaoxuan, and Cardiac Surgery Chief Physician Wang Honglu support. Ms. Liu’s condition improved day by day under the joint consultation of the brothers’ departments and under the comprehensive treatment of ECMO, ventilator, anti-infective drugs, and bronchoscopy treatment. After 10 days of ECMO treatment, on February 3, the third day of the new year , Ms. Liu successfully removed ECMO. Weaned from ventilator after 25 days in ICU. At the same time, he was given active bedside rehabilitation treatment by the rehabilitation department, and was discharged from the hospital on February 25th.
ECMO Popularization
Introduction by Chief Physician Si Min, Director of the Department of Critical Care Medicine, Jinan Central Hospital:< /p>
ECMO is the English abbreviation of Extra-corporeal Membrane Oxygenation, which is commonly referred to as artificial lung, membrane lung, and artificial heart-lung apparatus. ECMO is a A continuous extracorporeal life support method, which supports the heart and lung functions through extracorporeal equipment, so that the heart and lungs can rest and buy time for the disease to be cured. Clinically, it is mainly used in acute, severe, and reversible respiratory failure with ineffective conventional treatment and high fatality rate. In the past two years, ECMO has become the most important support method for cardiopulmonary failure, saving many critically ill patients. It reflects the critical care level of a department and a hospital.
< The principle of p>ECMO is to drain the blood from the body to the body through the venous or arterial cannula, and through the oxygenator, that is, the membrane lung, gas exchange is carried out, so that the venous blood is oxygenated into arterial blood, and then the blood is transported into the body, It maintains the perfusion and oxygen supply of various organs of the body. It is similar to the extracorporeal circulation machine during cardiac surgery, and supports life when the heart and lungs “strike”. ECMO is widely used in severe pneumonia, massive pulmonary embolism, fulminant myocarditis, acute myocardial infarction, cardiac cardiac arrest, shock, poisoning and even severe trauma.