After hanging up the caller, talk on the phone again.
It turned out that while she was away from Guozhi, everyone followed the consensus of the doctors after the morning meeting and started to try the lung recruitment operation during a series of preparations before the patient recovered and was weaned off the machine, but something seemed to go wrong.
The call came from Director Wang himself. He asked her in confusion: "Didn't you say that the patient is almost ready to be weaned off the machine?"
You can't eat hot tofu in a hurry, this saying is also very applicable clinically.
Originally, after having another patient, the one who should be most anxious was Xie Wanying, but now it seems that she is not at all. It means that whether the doctor is anxious or not actually depends on how confident the doctor himself is in controlling the patient's condition.
Listening to Director Wang's extremely anxious words, Xie Wanying only remembered that she had not said that the patient could be weaned from the machine in the morning.
ECMO weaning itself is a very complicated matter.
Doctors cannot simply wean the patient off the machine and wait until the patient is no longer able to intubate the patient. You must know that after the femoral artery is pulled out, the blood vessel wall needs to be repaired. This shows how much damage to the patient's blood vessels is caused by putting the patient on the machine.
There are only a few blood vessels in the patient's own body, and it is impossible to have unlimited important blood vessels for doctors to make multiple attempts. Protecting blood vessels has always been one of the key considerations for clinicians.
Moreover, this patient was put on a ventilator and a hemofiltration machine in addition to the ecmo machine. Which machine should be withdrawn first and which one should be removed is a question that requires serious consideration by the doctor. Even if it is prudent, the doctor will try to stop the machine for 24 hours without extubating it before weaning it off.
Make a decision after observing.
Her previous suggestion of adjusting ventilator parameters to perform lung recruitment training on patients is to inflate the patient's collapsed lungs and promote early recovery of the patient's lung function. This is actually just the first step in the recovery process of the patient's lung function before weaning the patient off the ventilator.
Don’t forget that Mr. Zhang uses vaecmo mode for patients, which includes support for the patient’s heart function. If you want to withdraw membrane lung, in addition to observing the patient’s lung function, heart function is also essential.
To sum up, the patient's cardiopulmonary function should be restored to the threshold before he can withdraw from membrane lung surgery. The calculation of cardiopulmonary function indicators requires very complicated verification work, and it cannot be determined simply by looking at a blood report or other single report.
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Such as cardiac function indicators, in addition to daily observation of membrane lung machine parameters and electrocardiogram and other routine items, doctors must perform special cardiac function examinations before weaning off the membrane lung machine. As mentioned before, transesophageal echocardiography can more clearly define cardiac function.
Figure inspection.
In addition to instrument examination, the patient's medication status is also a very important reference value for doctors. For example, if you do not want to intubate after the machine is weaned, the ideal state is of course to have a method that can replace the machine. The first choice is vasoactive and positive.
Inotropic drugs. Whether drugs can be used to replace the effect of the machine just in case requires clinical judgment and experiments before weaning the machine off.
Generally speaking, when trying to reduce the membrane pulmonary flow before weaning the machine and injecting a certain amount of the above drugs while trying to wean the machine, a rough assessment can be made.
After listening to the series of lectures given by Mr. Xie on the phone, Director Wang from Guozhi ICU once again deeply felt the importance of listening to Mr.
I need to go to Mr. Zhang again and let Mr. Zhang retain talents.
Without Teacher Xie's guidance, they would have inevitably tormented the patients as guinea pigs as they fumbled around, and they might even have tortured the patients to death.
