ECMO Machine – Credit Wikipedia
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This morning we have a detailed, and quite sobering account of one patient diagnosed with the H7N9 virus who remains in critical condition after being initially hospitalized on March 20th.
This patient, who is #3 on the ECDC case listing, is a 35 year-old man from Chuzhou, in Anhui province who reportedly had exposure to poultry.
The Jiangsu report is a machine translation, and as such is a bit syntax-challenged, but it is worth wading through the narrative.
In it we learn:
- After initially being placed on a ventilator, the patient was then moved to an ECMO (Extracorporeal Membrane Oxygenation) machine, where the burden of pumping and oxygenating the blood is taken from the heart and lungs, to give them time to heal (see The ECMO Option).
- The patient is described as suffering severe lung damage, septic shock, liver damage, and acute renal failure.
- The patient has received - in addition to standard rehydration and nutritional IV support - anti-virals, expectorants, immune enhancement (unspecified), and vasopressors to maintain blood pressure and perfusion.
- The patient is also undergoing hemofiltration (a form of dialysis) used for renal failure.
- This narrative also highlights the isolation techniques in use in this patient’s care.
- The patient remains in critical condition.
Up until a week ago, H7 influenza infections reported in humans have nearly always been characterized as mild, often presenting with little more than conjunctivitis.
This new H7N9 virus has now produced 20 known cases, six of which have proved fatal. Many more cases are reportedly in serious or critical condition.
A big unknown at this time is whether there are mild, undetected cases, not being captured by current surveillance efforts.
This from Jiangsu Health.
Anhui membership of human infection with H7N9 avian flu patients still rescue in
Published :2013 -4-7
March 20, Chuzhou go to Nanjing, where a 35-year-old man infected with the H7N9 avian flu patients Mr. Han, Zhongda Hospital, Southeast University, is still receiving treatment.
Patients admitted to hospital, his condition is very critical. Big hospitals for this purpose, the establishment of the treatment group, known in our intensive medical experts, under the leadership of Critical Care Medicine Branch of the Chinese Medical Association, chairman of the Hospital of Zhongshan University Professor Qiu Haibo, director of Critical Care Medicine, and actively carry out rescue work.
Early in the given conventional treatment of invasive mechanical ventilation, lung recruitment is still difficult to maintain oxygen saturation case, the treatment group adopts the international advanced technology of extracorporeal membrane oxygenation (referred to ECMO respiratory replacement therapy, commonly known as artificial lung) the patient's oxygen saturation and oxygen supply is maintained, and the rest of the damage lung and protection.
Actively given anti-viral, expectorant, immune enhancement, support and maintenance treatment of nutritional support and other organ function.
However, in patients with pulmonary infection due to go to Nanjing and extremely serious injury, and has appeared septic shock and liver injury, given rehydration supplement effective circulating blood volume and use of vasoactive drugs to maintain blood pressure and tissue perfusion in patients with lung injury and the shock does not get better, and the emergence of acute renal failure.
To patients with severe infection has led to multiple organ damage Zhongshan University hospital for treatment group to patients HEMOFILTRATION for the first time. The course of the disease, severe lung injury, and merge the high cardiac output, the treatment group also uses high-frequency oscillatory ventilation and prone position ventilation in the treatment, which is today one of the most effective treatment of severe acute respiratory distress syndrome.
The patients with confirmed human infection of H7N9 avian influenza, the National Health and Family Planning Commission, the Health Department of Jiangsu Province attaches great importance to the Expert Group of the National Health and Family Planning Commission Expert Group, Jiangsu Province came to the hospital several times to guide clinical treatment work.
Large hospitals not only for patients disbursements also specially arrange patient in independent isolation ward, multidisciplinary experts work together closely with meticulous care, and medical care. In the past few days, as the core of the health care team to Zhongshan University Hospital Critical Care Medicine bull by the horns, and not afraid of hard work to treat the Anhui patients. Because patients in critical condition who piping, the course of treatment and danger, doctors always monitor changes in condition, to constantly adjust treatment measures; care team in three shifts, 24-hour intensive care.
Medical personnel wearing Geli Fu, do not take into account any risk, stood at the patient's bedside, ready to respond to a variety of rescue and care, physical exertion out of the isolation ward, medical staff often drenched in sweat. Prone position ventilation in the treatment of patients with heavier wear Geli Fu into the negative pressure isolation rooms, need 4-6 medical staff to patients stand up to the prone position, 3-4 times a day this stand up to the medical staff take turns Go to the isolation ward for patients prone position ventilation therapy.
The hospital strictly do the various protective isolation and infection management in the prevention and control of early contact with 13 medical staff of the patient's medical observation, were not unusual.
At present, the patient's condition is still very critical, life is in danger at any time. The treatment group of experts is to rescue the patients.
