Because he was in the system operating room, Zheng Ren was not particularly impatient. This is an unparalleled advantage for others, and Zheng Ren is already used to it. He silently watched the experimental subject's condition deteriorate and began to measure various values.
Laboratory test values showed that the subject had symptoms of metabolic acidosis and acute renal failure.
Gas embolism may occur during ECMO use, and Zheng Ren knows this. It is estimated that gas embolism blocked the renal artery, and there were cases where the operation failed before the operation was completed.
It would be nice to find out. Zheng Ren is in a stable mood. The significance of the system operating room is here, to discover the problem in advance and study what to do to avoid this situation as much as possible.
Confirming that there was a problem with the kidneys, Zheng Ren completed the lung transplant operation, but did not leave the system operating room. Instead, he performed a renal angiogram on the experimental subject.
The final conclusion proved Zheng Ren's judgment - gas embolism.
After placement of ECMO, liver and kidney function should be improved because ECMO can improve peripheral organ perfusion.
Looking for similar information in journals, there was very little relevant information. Zheng Ren could only rely on limited information and his own imagination to make judgments.
Worsening kidney function may be a sign that ECMO is malfunctioning or may indicate pre-existing kidney disease. Zheng Ren tried several methods and discussed with Lao He, and finally decided to use continuous renal replacement therapy as a pipeline independent of the ECMO system to avoid air embolism.
The cause of persistent metabolic acidosis may be hypoperfusion of any organ, tissue necrosis, or distal limb infarction. Oxygenator failure can manifest as massive hemolysis. Distinguishing hematuria, disseminated intravascular coagulation, and hemolysis requires emergency diagnostic examination, continuous intraoperative measurement, and timely treatment are very important.
One problem after another was solved, Zheng Ren tirelessly pulled Lao He to study.
Every time the problem was verified and solved, Zheng Ren discovered that in addition to failure caused by renal gas embolism, there is a 15% possibility of acute liver failure when using ECMO.
Because Xiao Shitou had just completed two interventional embolization surgeries for liver cancer, his liver function was relatively poor. Liver failure is also a top priority for surgery. Zheng Ren didn't want to show off his skills and completed the liver transplant at the same time as the lung transplant.
The transplant of one organ, let alone more organs, is afraid that a small stone will not be able to withstand it.
Finally, I decided with Lao He to measure the liver function every 10 minutes during the operation. If the small stone still progresses to a persistent increase in bilirubin or an acute increase in liver enzymes despite the appropriate ECMO flow and blood pressure, it must be Liver dialysis using a molecular sorbent recirculating system.
"Lao He, do we have liver dialysis during the operation?" Zheng Ren asked.
"No, only Xiehe and Didu have liver and gallbladder surgeries in the Imperial Capital." Lao He said, "We don't do as much liver surgery as they do, and this kind of situation is not common, so the equipment is not available for the time being."
Zheng Ren didn't hesitate and called Zhou Chunyong.
Borrowing a piece of equipment is easy to borrow and return. Dean Bao Longtao, the chief dean of the Imperial Capital, would not embarrass himself because of this matter.
Lao He was particularly helpless. In his opinion, even if there was a problem with liver function, it was still too late to go back and do it again. But Boss Zheng showed that he must make the operation perfect, so he didn't say much.
After nearly 10 hours of discussion and brainstorming, Lao He had been completely squeezed out by Boss Zheng.
Seeing Boss Zheng energetically going to the operating table for surgical training, Lao He held 12 A4 sheets of records in his hand and slowly closed his eyes.
There are so many details that need to be paid attention to in anesthesia, ECMO, and extracorporeal circulation. What about surgery? I guess there are more points to pay attention to.
"Lao He, do you need some Red Bull?" Ringer's voice came.
"Ah? Lin Ge, why are you here?" Lao He was startled for a moment. What time is it? Why Lin Ge... Do you need to ask? Lin Ge is also planning to stay in the community hospital for a while and do the logistics work.
In the era of Director Mao, the Department of Science and Education was almost transparent from a clinical perspective, and it basically did nothing serious other than asking for money from trainee doctors. There is a smell of staleness in the air, and when it comes to science and education, clinicians frown.
This was Lin Chu's job, but Lao He was still a little uncomfortable with it.
He wanted to say hello to Ringer, but his eyelids seemed to be standing together, and it took a lot of effort to open them.
"If that doesn't work, just go back and take a nap." Lin Ge advised. "I see that you have exhausted too much energy. I guess you will be useless tonight. Staying here is of no use, and the efficiency will be low. It's not a day thing. I think what Boss Zheng means is that this is a marathon."
"Well, Boss Zheng is still young, in good health, and full of energy." Lao He glanced at Zheng Ren, who was standing silently operating under the shadowless lamp, sighed and said, "My old arms and legs are really not good anymore."
"What were you discussing just now?"
"Boss Zheng took me through the anesthesia work of the operation from beginning to end." Lao He said, "The model of intubation, the depth of intubation, the frequency of the ventilator, tidal volume, end-expiratory pressure... and then ECMO There are various matters that need to be paid attention to during the treatment, as well as preparations for dialysis of the kidneys and liver.”
"Normally..."
"Chu Lin, how demanding is Boss Zheng?" Lao He said, "Hepatobiliary has applied several times to get intraoperative liver dialysis equipment, but it has not come in yet. Boss Zheng is in charge of the Imperial Capital Hepatobiliary loan equipment to ensure that everything is perfect. "
"I heard it, and I was just about to ask you, does it make sense to borrow this thing?" Linge lowered his voice and asked.
"Of course it makes sense. Once bilirubin rises during the operation, immediate liver dialysis will have a much better effect than symptomatic treatment after the operation." Lao He said, "But the meaning...it's just that. If it were anyone else, I guess we can just deal with it like this. The operation will not be delayed for a long time, and it is better to go back for dialysis during the operation. And not many people know about intraoperative kidney dialysis, so this is a very cutting-edge treatment."
"Look at what you said." Ringer smiled.
"Chu Lin, I'm not joking." Lao He said seriously, "If you don't believe me, ask the clinicians. When they say dialysis, it means kidneys. Not many people know about intraoperative liver dialysis."
Lin Ge nodded, and he raised the level of the incident again.
Whatever Boss Zheng cares about, he must care about it. There is nothing to say. For a possible problem, it doesn't matter how much effort Boss Zheng put into going to the Imperial Capital to borrow equipment.
If it weren't for the fact that the age difference between Boss Zheng and the young patient wasn't that big, Lin Ge would have even thought that the young patient was Boss Zheng's illegitimate son. If it weren't for his own son, who would be willing to go to such great lengths to prepare for surgery and undergo treatment
Treating patients as if they were family members, Dean Yan would say this during every weekly meeting of the hospital. There are not many doctors who can really treat their patients like family.
Boss Zheng... Even Lin Ge felt that he had gone too far.