"Inflammatory storm" attack, oxygenation index drop to 1%, cardiac arrest After three escape, novel coronavirus pneumonia critically ill patient Yan Qiang finally pulled out the endotracheal intubation in 6 days, leaving the invasive ventilator and usher in the new life in February 26th.
The novel coronavirus pneumonia, more than 30, is not known to Han Jie in the contest of "death". On February 13, he had a sudden respiratory failure, and his life was in danger. The doctors and nurses almost "blinded" the big blood vessels at the edge of his hospital bed and used the ECMO system for him to take the young life back from the "God of death".
In February 19th, when novel coronavirus pneumonia patients who had recovered and discharged from the hospital were taken together in the Western District of Wuhan Union Hospital, 31 people held an apple in their hands. Liu Xiaojuan, a member of the Beijing medical team and head nurse of the internal medicine department of Chaoyang Hospital in Beijing, found that she did not know when the discharged patients would continue to pass the apple to the patients still in treatment.
"Apple's message is peace, but also confidence. More and more serious patients are recovering. I think the turning point will come soon. " Liu Xiaojuan said.
The invincible trust of life
The medical staff in the 16 ward area of the East Hospital of Wuhan University People's Hospital experienced a thrilling experience.
Novel coronavirus pneumonia was diagnosed as severe I in the February 9th, and Wu Xiongfei was admitted to the hospital because of chest tightness, wheezing and dyspnea. First level nursing, non-invasive ventilator assisted respiration, hormone anti-inflammatory, antiviral, anti infection, expectorant Under the individualized diagnosis and treatment plan, Yan Qiang's situation began to improve.
Unexpectedly, on the afternoon of February 11, Yan Qiang's blood oxygen saturation suddenly dropped to 79%. An urgent blood test showed that the "inflammatory storm" suddenly hit!
"Inflammatory storm" is the over reaction of cytokines, which is mainly caused by the over reaction of human immune system against external viruses and infection inducements. It is an important node for the transition from light illness to severe illness and critical illness, and it is also one of the important reasons for the death of severe illness and critical illness.
"In case of emergency, plasma exchange must be carried out immediately, or multiple organ failure will occur!"
Wu Xiongfei immediately organized doctors and nurses to discuss, and the "blood purification team" in the east hospital area quickly took the initiative, using heat circulation double plasma exchange (DFT), ec-2a20 membrane plasma separator for CVVH, plasma dialysis filtration (PDF) multiple blood purification modes, to remove inflammatory storm factors. After 6 hours of treatment, Yan Qiang's blood oxygen saturation finally returned to more than 98%.
Yan Qiang's condition is unpredictable, and the development of the virus is changing rapidly. On the morning of February 20, the danger came again! He had sudden dyspnea, and the inflammatory factors rose sharply again, and his life was in danger.
Wu Xiongfei: need emergency endotracheal intubation!
However, at the critical moment, death once again showed a ferocious face - Yan Qiang's condition turned sharply, the oxygenation index fell to a single digit, the respiratory rate was as high as 80 times / min, the oxygen saturation was only 67%, the blood pressure could not be measured, and the feces and urine were incontinent.
A difficult problem lies in front of us: if we do not intubate the trachea in time, the patient will die of multiple organ failure caused by inflammatory storm at any time; if we intubate the trachea, the patient's current physical conditions may not be able to bear the risk in the intubation process.
The pace of death is approaching, "can't watch death take him away!" Wu Xiongfei and Lai Wei, a doctor of critical medicine in West China Hospital of Sichuan University, decided to intubate first.
Lift the patient's mandible, open the airway, assist breathing with the respiratory sac, put in the intubation laryngoscope, insert the tracheal intubation Qiao Qianqian, who has novel coronavirus pneumonia experience of more than 40 times, successfully intubated in a few seconds. Lai Wei quickly connected and adjusted the invasive ventilator, and the strict oxygen saturation rose rapidly. Everyone was relieved for a while.
How to expect, 2 minutes later, Yan Qiang's oxygenation index plummeted again, as low as 1%, and her heart stopped suddenly! All the medical staff on the scene cooperated quickly to rescue, cardiopulmonary resuscitation, intravenous medication... All the people were fighting against the clock, all the people were working hard.
Finally, a few minutes later, Yan Qiang's heart rate and oxygen saturation rose again, and the flashing numbers on the monitor began to return to safety step by step. Yan Qiang turns the corner.
At this time, Wu Xiongfei found that everyone's clothes had been soaked. A breathtaking endotracheal intubation, a close cooperation of multi-disciplinary experts of the joint medical team, finally recaptured life from death.
Under the epidemic situation, we have witnessed too much heartbreaking despair and grief of life and death. Wu Xiongfei said: "patients give their lives to us. This kind of trust and trust makes me feel that there is a kind of power to push myself to strive to surpass the God of death and seize life."
The mission of doctors that cannot be given up
The sudden deterioration of Han Jie's condition is also surprising.
On February 13, doctors in the third ward of the East Hospital of the people's Hospital of Wuhan University found that Han Jie, in his 30s, was in a state of rapid decline. Even though he had used ventilator-assisted ventilation, his blood oxygen saturation could only be maintained at 67%. The respiratory failure of Han Jie began to lose consciousness, the threat of death came again!
At the critical moment, Ding Renyu, a member of Liaoning medical team and professor of critical medicine of the First Affiliated Hospital of China Medical University, decided to use ECMO support immediately after emergency assessment!
Extracorporeal membrane oxygenation (ECMO), commonly known as "artificial lung", provides continuous extracorporeal respiration and circulation for patients with severe cardiopulmonary failure, and is the last line of defense to save the lives of patients with severe disease.
Time in minutes and seconds, the dying Han Jie has been unable to be transferred to the operating room for ECMO rescue. There is only one way in front of us: to operate on the spot in isolation ward and build ECMO vascular access.
No delay. Zhou Xiaoyang, director of the intensive care unit of Cardiology, immediately transferred to the ECMO mainframe. Xia Wei, head nurse, provided special ECMO consumables in an emergency. Deng Hongping, director of vascular surgery, quickly put on protective clothing and surgical clothes and entered the isolated ward. Multidisciplinary medical staff gathered in an instant to save the young life.
At that time, Han Jie's heart function was intact, and Ding Renyu and Deng Hongping decided to use the "artificial lung" mode of VV pathway. This mode needs to establish blood channels in two femoral veins of patients, put drainage and return blood pipes into the inferior vena cava, lead human blood out of the femoral vein, absorb oxygen through the membrane lung, discharge carbon dioxide, and return to the other side of the femoral vein under the promotion of the pump, temporarily replacing the human body's own lung function.
In the isolation ward, there is no special blade or lamp in the operating room. Heavy protective clothing makes it difficult for medical staff to breathe. Soon, the fog will cover the goggles and the vision will be affected. It is difficult to dissect blood vessels because of the common hospital bed which can't be raised, the overweight body shape and the deep femoral artery and vein.
Deng Hongping stooped in front of the hospital bed, relying on the accumulated experience of blood vessel operation, and relying on the hand and touch "blind exercise", separated the patient's femoral artery and femoral vein little by little.
As time went by, Deng Hongping and his assistant kept the posture of leaning down all the time. More than an hour later, the patient's ECMO vascular access was finally built successfully, and the channel of life was opened! At this time, all the medical staff were soaked, the goggles were covered with fog and sweat, even the shoes were soaked with sweat.
The doctors and nurses operated on the isolated ward to establish ECMO vascular access. /Drawings provided by the hospital
Han Jie's oxygenation immediately improved, and his blood oxygen saturation increased to more than 95%. He was pulled back from the life and death line by the doctor. This difficult pass finally came through.
Novel coronavirus pneumonia is not a new technology for severe treatment. ECMO is not targeted at new crown pneumonia. But novel coronavirus pneumonia patients often suffer from severe respiratory insufficiency and hypoxemia, which are in line with the indication of ECMO and thus become a protective line between death and patients.
Remembering that day's "blind puncture" of big blood vessels, Deng Hongping still had lingering palpitations: critical patients were in critical condition and could not be delayed for a moment. As long as there is any hope, we can not give up. This is the mission of a doctor.
The unforgettable grace of rebirth
As one of the novel coronavirus pneumonia patients who recovered from the Western District of Wuhan Union Hospital, Liu Gang, 47, is obviously the most excited one. Knowing that he could be discharged from the hospital, he spent an hour the morning before yesterday, writing a thank-you letter on three pages.
"When I was at the tipping point, it was almost over." Liu Gang described his state when he was just admitted to hospital on February 5, "he couldn't even stand up. He had difficulty breathing when he got up from bed and went to the toilet. First, he kept a high fever of 39.5 degrees, and then he coughed for three consecutive days. When he got up in the morning, he coughed and could see blood."
In Xiehe West Hospital, Liu Gang received careful treatment from Zhang Jianchu's team. Three days later, his condition began to be controlled, stabilized and gradually recovered. Liu Gang kept repeating that the medical staff took care of him: "they really sent the food to my mouth. They were not afraid of being dirty and tired. They encouraged me and encouraged me every day. Without them, I couldn't leave the hospital..."
During the conversation, we found that his palm was full of crooked words.
Liu Gang stretched out his hand: "this is the name of the medical staff I want to thank, Professor Zhang Jianchu, Dr. LV Yanling, Dr. Chen Ping, Dr. he Xinliang, head nurse Wang Fang I'm afraid I'll forget, so I'll write their names in my hand. "
Liu Gang said that he had never seen the faces of the medical staff through the mask, but he could recognize who they were by listening to the voice.
In this handwritten thank-you letter, Liu Gang wrote to the medical staff: "when the epidemic war is fully won, put down your tired body and sing together to celebrate the great victory. At that time, the people of Wuhan will feel the vitality and charm of Wuhan in the past with full enthusiasm and gratitude. At that time, the cherry blossom in Wuhan will open for you. "
As a designated hospital for severe patients, Xiyuan District of Wuhan Union Medical College Hospital currently has 11 medical teams from Beijing, Guangdong, Heilongjiang, Shaanxi, Hunan, Liaoning, Gansu and other parts of the country, with 1059 medical and nursing personnel.
Of the 31 patients discharged on the same day, 16 were from the West ward on the 8th, 10th and 12th floors of Beijing medical team. Tang zilen, chief physician of Emergency Medicine Department of Chaoyang Hospital in Beijing, said that the situation of each patient is different, which is very important for individual treatment of each patient. It seems to be the same age, the same disease, but the development of the disease is different. It is possible to win the battle only by supporting organ function, immune function and all-round treatment according to different situations of each person.
Liu Xiaojuan could go back to have a rest after taking over the shift in the morning, but she waited until the afternoon to see off the serious patients. "It's very exciting to see so many people recover. We hope to give confidence to the people of Wuhan and the medical staff of Wuhan. We are able to treat these severe patients. "
31, not only a simple number, but also a day and night watch and bitter expectation of 31 families, and a letter from more families