6.2. Treatment of severe and critical cases
- The principle of treatment: on the basis of symptomatic treatment,
actively prevent and treat complications, treat basic diseases and
secondary infection timely.
- Respiratory
support: A. oxygen therapy given by the nasal catheter or mask and
assess the effect of oxygen inhalation. B. High flow oxygen therapy or
noninvasive mechanical ventilation when the respiratory distress or
hypoxemia cannot be alleviated after standard oxygen therapy.
Intubation and invasive mechanical ventilation, if the condition does
not improve or even worsen. C. Lung protective ventilation strategies:
High positive end-expiratory pressure (PEEP) can be appropriately used
to keep the airway warm and humid.
- Circulation support: based on adequate fluid resuscitation, improve
microcirculation, closely monitor the changes of blood pressure, heart
rate and urine volume of patients, as well as the surplus of lactate
and alkali, and apply hemodynamic monitoring if necessary.
- Rescue
treatment: Rescue treatment: applying lung expansion for patients with
severe ARDS. Using extracorporeal membrane oxygenation (ECMO) soon as
possible, when the mechanical ventilation has no effect. ECMO
indications: A. FiO2 > 90%, oxygenation
index is less than 80mmHg for more than 3-4 hours; B. use VV-ECMO mode
for the patients with airway platform pressure ≥35cm
H2O and simple respiratory failure. if circulatory
support is needed, VA-ECM0 mode is selected. When the basic diseases
are under control and the cardiopulmonary function shows signs of
recovery, the machine withdrawal test can be started.
- Renal failure and renal replacement therapy: search for the cause of
renal function damage. Pay attention to the balance of the fluid,
acid-base and electrolyte, and the supplement of heat and trace
elements. Continuous renal replacement therapy (CRRT) can be used in
the severe patients.
- Other treatments: Chinese medicine treatment, convalescent plasma
therapy, blood purification treatment, immunotherapy and so on.