What’s so scary about atelectasis?
The alveoli are not open and there is no gas exchange, which means that the patient is severely hypoxic and may even die of suffocation. The symptoms of hypoxia and suffocation are called respiratory distress syndrome, or RDS in English. In adult patients, it is called adult-type RDS, or ARDS with an A. The respiratory distress syndrome of newborns is NRDS with an N. Why are the two separated? Because the causes of respiratory distress syndrome in adults and newborns are different.
Adult ARDS, like SARS, which left a deep impression on us, is mainly caused by severe infection. In the lungs of patients with severe infection, the virus inactivates a large amount of pulmonary surfactant, abbreviated as PS, and the alveoli collapse.
At the same time, a large amount of mucus is produced, which can block the bronchi and cause mechanical obstruction of the bronchi that cannot be eliminated, eventually leading to severe hypoxia and death of the patient.
The treatment plan is definitely to fight infection first. In the absence of specific drugs for a certain virus, the effect of fighting infection can only be greatly reduced, and the doctor's only means are physical methods such as bronchoscopy and patting the back to cough up phlegm. These remaining life-saving methods become particularly important in the rescue of such patients. Therefore, a large number of nurses are needed in this ward to assist in the rescue. The rest can only rely on the patient's own immune system to fight infection. However, relying on the patient's own immune system to fight infection has another fatality, which is what we can hear doctors call immune storm, which is also one of the important causes of death in such patients.
It can be seen that for patients with adult respiratory distress syndrome, the current medical means are limited, which has always made clinicians very afraid. When encountering new respiratory virus infections such as SARS, the only option is to take more distant and ancient measures such as isolation. There is no way, there is no medicine to treat it.
In addition to infection, adult respiratory distress syndrome may be caused by trauma, foreign body inhalation and other factors. The process is also more dangerous and has a high mortality rate.
In comparison, NRDS, neonatal respiratory distress syndrome, mainly occurs in premature infants. The cause of this type of infant is relatively simple and seems to be easier to treat.
To understand the source of neonatal respiratory distress syndrome, we must first understand the mechanism of a normal baby leaving the mother's body. First, the fetus does not breathe on its own in the mother's womb, and the lungs are not atelectasis and the alveoli are not inflated. After birth, the baby needs the alveolar surfactant given by the mother to automatically inflate the baby's lungs. Premature babies leave the mother's body early and lack this substance, so the alveoli cannot be inflated and opened, causing breathing difficulties.
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Let's go back to the lung-boosting injection that Dr. Hu mentioned at the beginning of the discussion. The most commonly used drug in clinical practice is hormonal drugs such as dexamethasone, which utilizes this mechanism of action to induce the fetal type 2 lung cells to produce alveolar surfactant PS, ultimately avoiding white lung and respiratory distress.
The current situation is an emergency. The doctor was unable to give the mother a lung-boosting injection in advance. As a result, the baby, who was born prematurely, had symptoms of respiratory distress, which was within the expectations of the medical staff as Dr. Hu said.
Since we know that the baby's respiratory distress is caused by the lack of this substance, can we directly give the baby alveolar surfactant? Of course we can. The question is, where can we get this substance in the clinic?
This medicine is expensive. In general, hospitals that do not have a special neonatal department will not have this kind of specialized expensive medicine.
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