Chapter 3526: 【3526】just in case
Chapter 3526 [3526] just in case
After hanging up the phone with Faxiao, come back to the phone again.
It turned out that when she was away from Guozhi, according to the consensus of the doctors at the morning meeting, everyone began to try the lung recruitment operation during the series of preparations before the patient's recovery and weaning off the machine, but it seemed that something went wrong.
Director Wang personally called to ask about the phone call, and asked her incomprehensibly, "Didn't you say that the patient can almost be weaned off?"
I can’t eat hot tofu in a hurry. This sentence is also very applicable in clinical practice.
After having another patient, it was Xie Wanying who should be most anxious, but now it seems that she is not at all. It shows whether the doctor is in a hurry or not, in fact, it depends on how much confidence the doctor has in controlling the technology of the patient's condition.
Listening to Director Wang's extremely anxious words, Xie Wanying only remembered that she didn't say that the patient could be weaned off in the morning.
Ecmo weaning itself is a very complicated thing.
Doctors can’t simply turn off the patient’s machine, and wait for the patient to fail before intubating. You know, after the femoral artery is pulled out, a blood vessel wall repair operation is required, which shows how much damage to the patient's blood vessels is caused by going on the machine.
The patient has so few blood vessels in total, it is impossible to have unlimited important blood vessels for the doctor to make multiple attempts. The protection of blood vessels has always been one of the key points considered by clinicians.
Besides, this patient was on a ventilator and hemofiltration machine in addition to the ecmo machine. Which of the machines should be withdrawn first and then withdrawn is a question that requires serious consideration by doctors. Even if it is prudent, the doctor will try to stop the machine for 24 hours of observation without extubation before making a decision.
She suggested adjusting the parameters of the ventilator to do lung recruitment training for the patient, which is to inflate the collapsed lung of the patient and promote the early recovery of the patient's lung function. This is actually just the first step in the pulmonary function rehabilitation process before the patient is weaned off the machine.
Don’t forget that Mr. Zhang uses the vaecmo mode for patients, which includes support for the patient’s heart function. If the membrane lung is to be withdrawn, in addition to observing the patient's lung function, the heart function is also essential.
To sum up, the membrane lung can be withdrawn only after the patient's cardiopulmonary function has recovered to the threshold index. Cardiopulmonary function index measurement requires very complicated verification work, and it cannot be determined simply by looking at a blood report or other single report.
Such as heart function indicators, in addition to daily observation of membrane lung machine parameters and electrocardiogram and other routine items, doctors must do special heart function tests before weaning off the machine, which is transesophageal echocardiography, which has been said many times before and can be more clear about heart function. Figure check.
Not only instrument inspection, but also the patient's medication status is a very important reference value for doctors. For example, if you do not want to intubate after weaning, the ideal state is of course to have a means that can replace the machine, and vasoactive and inotropic drugs are the first choice. Whether it is possible to use medicine to replace the effect of the machine just in case, requires clinicians to do research and judgment and experiment before weaning the machine.
Generally speaking, when the membrane lung flow is reduced before weaning, a certain amount of the above-mentioned drugs can be injected while trying to wean, and a relevant rough assessment can be made.
After listening to the series of lectures given by classmate Xie on the phone, director Wang of Guozhi ICU once again deeply felt the importance of listening to teacher Xie's lectures. I have to go to Mr. Zhang again to let Mr. Zhang retain talents.
Without the guidance of Teacher Xie, they would inevitably treat the patient like a guinea pig when they were groping now, and they might even kill the patient.
(end of this chapter)
