After hanging up the phone with Faxiao, call again.
It turned out that when she left Guozhi, according to the consensus of the doctors after the meeting in the morning, everyone began to try the lung recruitment operation in the process of a series of preparations before the patient's recovery and weaning off the machine, but it seemed that something went wrong.
The phone call was made by Director Wang himself, and he asked her incomprehensibly, "Didn't you say that the patient can almost be weaned off?"
I can't eat hot tofu in a hurry, which is also very applicable in clinical practice. After having another patient, Xie Wanying should be the one who should be most anxious, but now it seems that she is not at all. It shows whether the doctor's mentality is in a hurry, in fact, it depends on how much the doctor's own technology controls the patient's condition.
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Listening to Director Wang's anxious words, Xie Wanying only remembered that she did not say that the patient could be weaned off in the morning.
Ecmo weaning itself is a very complicated thing.
The doctor can't say to turn off the patient casually, 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.
There are only a few of the patient's own blood vessels, and it is impossible to have an infinite number of important blood vessels for the doctor to try multiple times. The protection of blood vessels has always been one of the key points considered by clinicians. Besides, this patient was put 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 Which of the machines should be withdrawn first and then withdrawn is a question that requires serious consideration by doctors.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 patient without extubating the machine before weaning the machine.
Make a decision after 24 hours of observation. She previously 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.
. Don't forget that Mr. Zhang uses vaecmo mode for patients, which includes support for patients' 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
of. To sum up, the membrane lung can be withdrawn only after the patient's cardiopulmonary function has recovered to the threshold index. The measurement of cardiopulmonary function indicators requires a very complicated verification work, not simply looking at a blood report or other simple
A report can be concluded. 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.
Tract echocardiography. Not only instrument inspection, but also the patient's medication status is a very important reference value for doctors. For example, after weaning, if you do not want to intubate, the ideal state is of course to have a means that can replace the machine, and the first choice is blood vessels.
Active and inotropic drugs. 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. to again
Go to Mr. Zhang and ask Mr. Zhang to retain talents. Without Teacher Xie's guidance, they would inevitably treat the patient like a guinea pig when they were groping now, and they might end up tossing the patient to death.