After hanging up the phone with my childhood friend, I called him again.
It turned out that during the period when she was away from Guozhi, everyone followed the consensus of the doctors after the meeting in the morning and began to try the lung recruitment maneuver during a series of preparations before the patient's recovery and removal of the ventilator, but something seemed to go wrong.
Director Wang called her personally to ask, "Didn't you say that the patient can be weaned off the ventilator soon?"
You can't eat hot tofu in a hurry. This is also very applicable in clinical practice.
Originally, after having another patient, Xie Wanying should be the most anxious, but now it seems that she is not at all. Whether the doctor is anxious or not actually depends on how much control the doctor has over the patient's condition.
Listening to Director Wang's anxious words, Xie Wanying only remembered that she did not say in the morning that the patient could be weaned off the ventilator.
The removal of ecmo is a complicated matter.
Doctors cannot just remove the ventilator from a patient and wait until the patient is no longer able to function before inserting the catheter. You have to know that after the femoral artery is removed, a vascular wall repair surgery is required, which shows how much damage the patient's blood vessels will suffer from being on the ventilator.
Patients have only a few blood vessels, and it is impossible for doctors to have an unlimited number of important blood vessels to make multiple attempts. Protecting blood vessels has always been one of the key considerations for clinicians.
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Besides, the patient was on a ventilator and a blood filter in addition to the ECMO machine. Which machine should be removed first is a question that the doctor needs to think carefully about. If the doctor is cautious, he will not remove the tube before removing the machine and try to stop the machine for 24 hours before making a decision.
She previously suggested adjusting the ventilator parameters to perform lung recruitment training on the patient, which is to inflate the patient's collapsed lung and promote the early recovery of the patient's lung function. This is actually just the first step in the patient's lung function recovery process before the ventilator is removed.
Don't forget that Zhang Da Lao used the vaecmo mode for the patient, which includes cardiac function support for the patient. If the membrane lung is to be removed, in addition to observing the patient's lung function, the cardiac function is also essential.
In summary, the membrane lung can be removed only after the patient's cardiopulmonary function has recovered to the threshold index. The measurement of cardiopulmonary function indexes requires very complex verification work, and it cannot be determined simply by looking at a blood report or other single report.
For example, for cardiac function indicators, in addition to daily observations of membrane lung machine parameters and electrocardiograms and other routine items, doctors must perform special cardiac function tests before removing the machine, which is the transesophageal echocardiogram that has been mentioned many times before and can more clearly define cardiac function.
In addition to instrument examinations, the patient's medication status is also a very important reference value for doctors. For example, after the ventilator is removed, if intubation is not desired, the ideal state is of course to have a means to replace the machine, and vasoactive and positive inotropic drugs are preferred. Whether drugs can be used to replace the effect of the machine just in case requires clinical doctors to make judgments and conduct experiments before the ventilator is removed.
Generally speaking, when reducing the membrane lung flow before weaning off the machine, a certain amount of the above-mentioned drugs can be injected while attempting to wean off the machine, so that a 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. It was a little late for him to take out his pen to take notes. He couldn't help thinking that he would go to find Boss Zhang later and ask him to retain the talent.
Without Teacher Xie's guidance, they would inevitably treat the patients as guinea pigs when they were trying to figure out the method, and they might even end up killing the patients.
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