Final Critical Care: Where is the difficulty, how to attack it, and how to monitor it?

(Fighting New Coronary Pneumonia) The last severe treatment: where is the difficulty, how to attack, and how to monitor?

China News Service, Wuhan, April 3rd: The final critical treatment: where is the difficulty, how to solve the problem, and how to monitor?

China News Agency reporter Ran Wenjuan Yang Chengchen

The Wuhan epidemic has entered the final sprint stage. As of April 2, there were 239 severe cases and 110 cases of critically ill patients with new coronary pneumonia in Hubei Province. The "battlefield" has shrunk greatly, but the difficulty of attacking is not reduced.

Data picture: Medical staff working in ICU ward of East Hospital of Wuhan University People's Hospital. The Eastern Hospital of the People's Hospital of Wuhan University is one of the designated hospitals for severe patients with new coronary pneumonia in Wuhan. The hospital accepts both severe and critically ill patients. Photo by Zhang Chang from China News Agency

These patients are generally old, with many underlying diseases and multiple organ damage, making medical treatment extremely difficult. How to capture the last "fortress"? A reporter from China News Agency interviewed the relevant person in charge of the National Health Commission and the expert on critical care.

"Fighting" with the virus has been unknown for months

Since the outbreak of the epidemic, humans have been "fighting" with the new crown virus for months, and many unknowns remain to be resolved.

Jiao Yahui, an inspector of the State Administration of Health and Medical Administration's Medical Administration and Hospital Authority, spoke of the deceptive nature of the virus. "We don't know enough about this disease." Zhan Qingyuan, director of the fourth and fifth department of the Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, and deputy team leader of the medical team of the National Medical Team of Hubei, said that once a patient becomes critically ill, all organs Organs are attacked, including the lungs, immunity, blood, and heart system. "Patient death may be the result of a combination of the virus's full-body attack, but the performance in the lungs is more prominent."

Medical care goes to great lengths to treat patients, but experience needs to be accumulated from scratch. For example, Zhan Qingyuan, many of the early critically ill patients were diagnosed with ARDS (Acute Respiratory Distress Syndrome). But now, ARDS caused by neocoronary pneumonia is very different from typical ARDS, so the treatment methods are quite different. Even in the same patient, there are contradictions in their treatment. Jiao Yahui pointed out that anticoagulation and hemostasis conflicts occur at the same time, which is often encountered in the treatment of critical illness.

How to find the best balance point in treatment, test medical technology and hospital strength.

捋 Successful management process

After the outbreak, more than 40,000 doctors and nurses assisted Hubei, of which 19,000 were responsible for critical care. The first step in treating patients is to standardize the management process and let various medical teams work together.

Jiao Yahui introduced that the National Health and Medical Commission formulated a management system for the treatment of critically ill and critically ill patients in early February, requiring the establishment of a joint medical department, a nursing department, a hospital sense office, and an expert group to clarify unified command and management.

Hu Yu, president of Wuhan Union Medical College Hospital, said that the epidemic reflected insufficient beds, inadequate protective materials and equipment in critical care in Wuhan, and inadequate capacity building in the face of major health emergencies.

The reorganization of the Respiratory and Critical Care Medicine Team at the China-Japan Friendship Hospital took over a critically ill area in the Sino-French New City Hospital of Wuhan Tongji Hospital. Zhan Qingyuan recalled that the emergency team and ICU ward was a big challenge.

At that time, the team transferred an elite medical team from Beijing to Han and brought in more than 15 million yuan of rescue equipment. "But there are still many processes to combine these people and equipment to form a unified whole. At first, it was quite turbulent. After a week or so, the whole thing went smoothly."

Jiao Yahui also introduced that the medical quality management systems established on weekdays, such as the consultation system for difficult cases, the discussion system for death cases, and the overall care system, were also strengthened during the "wartime." In addition, a 24-hour critical illness reporting system has been specifically established to conduct inventory management of all critical cases.

Pass the gate forward without missing the best window period

The new crown pneumonia diagnosis and treatment plan was revised from the first edition to the seventh edition, behind which is the process of gradual understanding of the disease and the accumulation of diagnosis and treatment experience. During this period, moving the gate forward is the most important judgment.

"We emphasize that we must take effective measures more actively and not miss the best window of treatment." Jiao Yahui said that the diagnosis and treatment plan proposed various early warning indicators, such as respiratory frequency, oxygen saturation, and other indicators may become severe, clinical Doctors will be alert to intervention as soon as they are discovered.

Early implementation of tracheal intubation for patients is a consensus reached after clinical validation. "If the patient's oxygen saturation index does not improve after 2 hours of using a non-invasive ventilator, then tracheal intubation should be implemented as soon as possible." She recalled that in early February, the expert group of the Central Steering Group went to various hospitals to demonstrate and allay their concerns. Facts have proven that early application results in significant patient outcomes and prognosis.

In the ward in which Zhan Qingyuan's team is responsible, so far a total of 82 patients have been admitted, most of them have been discharged and 4 have died. "Three of them belonged to conditions that were not intubated when they first arrived, and they could not be treated in time for tracheal intubation."

Rescue is inseparable from the cooperation of multidisciplinary teams. "The rescue of critical illness is not only in the respiratory infection department, but also in the entire critical medical team. Experts in various fields such as nephrology, hematology, and immunology should be treated together." Jiao Yahui said.

Discharge patient health monitoring is an important work in the later period

Patients are discharged one after another. How will follow-up health monitoring be performed? Will there be sequelae after recovering from critically ill patients?

Zhan Qingyuan believes that the follow-up, observation, and intervention of patients with severe discharge will be the focus of attention in the later period. Severe infectious diseases have a great physical and psychological impact on patients, and both of them need to be healed.

He specifically pointed out that because the new coronavirus attacks multiple organs, each organ needs to be evaluated and checked during follow-up. However, targeted follow-up of different patients is also a difficult problem to be solved. We have a lot to do later. Zhan mentioned that the probability of sequelae, etc. is unknown, and a clear answer can only be obtained through long-term and accurate follow-up. (Finish)