Dazhong Net·Poster reporter Xu Ling correspondent Yan Liru reported from Jinan
“I forgot to order…”
Yes, this is 4 A scene in the intensive care department of Jinan Central Hospital on March 7.
At this time, the doctor was doing rounds when he heard Xiao Zhang, a 7-bed patient, say, “I forgot to order…”.
His words caused everyone to laugh, because this is the intensive care department, which treats all critically ill patients, and it is rare to hear patients say that they forgot to order meals. But this also means that he has recovered very well.
On March 29, Xiao Zhang from Jinan suddenly appeared unconscious and fell to the ground. After the family found out, they immediately sent Xiao Zhang to the emergency department of Jinan Central Hospital for treatment. After being sent to the hospital, Xiao Zhang’s consciousness slowly began to recover, and his body temperature was measured at 38.2°C, but he could not recall what happened at that time. The doctor immediately arranged for Xiao Zhang to undergo a CT scan of the brain, and there was no abnormality. Cerebrovascular disease was temporarily ruled out, and the family was relieved. The chest CT showed pulmonary infection. Subsequently, Xiao Zhang’s blood test results came out one after another, and the liver and kidney functions were abnormal. The initial diagnosis was: pulmonary infection, abnormal liver and kidney function, and immediately admitted to infectious diseases. Department of further treatment, given anti-infection, antipyretic and other symptomatic and supportive treatment. After treatment, Zhang’s body temperature finally returned to normal temporarily.
*Chest CT on admission
Sudden shortness of breath
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On March 30th, although the body temperature was normal, Xiao Zhang suddenly began to breathe quickly. Under the condition that the oxygen concentration was 5L/min, the partial pressure of oxygen was only 84mmHg, and the oxygenation index was about 200mmHg, which is a normal value. 400-500mmHg.
The oxygenation index (PaO2/FiO2) is an important index to judge the severity of acute respiratory distress syndrome (ARDS). The smaller the value, the more serious the condition.
The infectious disease team considered the patient to be acute respiratory distress syndrome caused by severe pneumonia, and the infection index was further increased on re-examination. At the same time, liver and kidney functions were progressively deteriorated, and the creatinine clearance rate was 21ml/min, which was an acute respiratory syndrome. Features of renal failure.
As the patient’s condition worsened, the infectious disease team actively treated the patient and continued anti-infective treatment after escalating antibiotics. However, the effect of drug treatment is not good, and it needs to be transferred to the intensive care department for advanced supportive treatment.
Comprehensive rescue by intensive care team
After the patient was transferred to the intensive care unit, he was immediately given non-invasive ventilator-assisted ventilation and intermittent prone position ventilation to correct the deficiency. Oxygen status, symptomatic and supportive treatment such as anti-infection, liver and kidney protection, and electrolyte balance correction should be given.
With the further improvement of the examination, the chlamydia pneumoniae antibody test was positive. The intensive care team considered the pulmonary chlamydia complicated with bacterial infection, adjusted the anti-infection plan, and gave moxifloxacin combined with Supeps deep anti-infective treatment, but The patient’s renal function is still deteriorating, the serum creatinine has reached 662 μmol/L, and the creatinine clearance rate is only 17.91 ml/min, which has reached the indication of hemodialysis. Actively search for the cause, and dynamically monitor the renal function. After several hemodialysis treatments, the renal function began to recover slowly, which was significantly better than before.
Why hemodialysis is needed
Hemodialysis is one of the ways of renal replacement therapy for patients with acute and chronic renal failure. It drains the blood from the body to the outside of the body, and passes through a dialyzer composed of numerous hollow fibers. It exchanges substances with the principle of convection, removes metabolic wastes in the body, maintains electrolyte and acid-base balance; at the same time, removes excess water in the body, and the whole process of returning the purified blood is called hemodialysis.
Hemodialysis is widely used in acute kidney injury, severe metabolic acidosis, hyperkalemia that is not easy to correct, drug or poison poisoning, etc.
*Xiao Zhang is undergoing hemodialysis treatment
prone position ventilation is effective
After about a week of treatment, Xiao Zhang’s condition has improved significantly, his body temperature is normal, his liver and kidney functions have improved significantly, his serum creatinine has dropped to 248μmol/L, and his oxygenation index is 400mmHg, the pulmonary oxygenation function basically returned to normal, and the non-invasive ventilator was withdrawn. Xiao Zhang was able to recover so well in a short period of time, and intermittent prone ventilation played a big role.
Prone ventilation is an adjunct to the treatment of acute respiratory distress syndrome. Its mechanism utilizes gravity to increase blood flow in the anterior chest and ventilation in the back, and improve gas exchange.
On April 14, Xiao Zhang had a chest CT scan, his lung infection was significantly controlled, and his mental state had improved a lot, and he had reached the standard of being transferred out of the intensive care department. At present, Xiao Zhang has been transferred to the Nephrology Department for specialist treatment, and it is believed that he will be able to recover and be discharged from the hospital soon.
*Recheck chest CT when the patient is discharged from the ICU