However, Director Fu of the Department of Respiratory Medicine said: "Intubation too early is not necessarily a good thing, I think non-invasive ventilation can already achieve the goal, and there is no need to have invasive ventilation." Because it is very troublesome to care after endotracheal intubation, a large amount of sputum is produced over time to block the airway, and the patient feels very bad. It is uncomfortable for anyone to insert a tube, and it is very painful for the patient to be inserted for many days, and sometimes a large dose of tranquilizer has to be used to keep the patient in a comatose state, which is not conducive to the observation of the patient's condition. ”

"So we still prefer not to be intubated and use non-invasive breathing when it is not necessary. As long as non-invasive breathing can be maintained, non-invasive breathing should be used, if non-invasive breathing cannot achieve the purpose of oxygen supply, and the oxygen saturation drops badly, then it will be converted to invasive breathing, and gradually approaching"

The current doctors in the intensive isolation ward are all business backbones drawn from various departments of the hospital, many of them are attending doctors and deputy chief doctors of the department, and even a few are chief doctors, on a par with Wu Hao. Therefore, although theoretically, the leaders of the hospital determined that Wu Hao was solely responsible for the intensive care isolation ward, but because everyone's administrative level was about the same, although they accepted his leadership in business, they did not necessarily listen to his opinions.

Wu Haojian's objections are all from the head of doctors in the respiratory and chronic disease departments, and those who support his opinion are basically intensive care doctors and respiratory doctors. He immediately understood that it was related to the doctor's personal treatment habits.

For chronic doctors, they do not need to take drastic measures to treat, so the use of drastic rescue methods is relatively rare, so they have developed a more stable treatment style. Intensivists and emergency physicians are more decisive in their actions, after all, the emergency and severe cases they see require very decisive treatment.

Once intubated, care and extracorporeal life support become more difficult. Respiratory physicians who are relatively unfamiliar with these chronic respiratory diseases are not as familiar with extracorporeal life support as intensivists and emergency physicians. This unfamiliarity is also a natural resistance to the use of invasive breathing.

In fact, Wu Hao is not completely sure of his judgment, but today he found this problem and raised it for everyone to think. After a number of people disagreed with him, he decided to share his thoughts further.

Wu Hao said: "Let me talk about why I proposed early intubation. This is not only because Dai Yunyang's previous case proves how important it is to be intubated in a timely manner, even if the patient does not have the indication to be intubated, but the blood oxygen saturation is very bad, and the patient does not have the initiating mechanism of hypoxemia, and needs to be intubated urgently. I've been wondering why there is such a patient, the oxygen saturation drops to 230% and still has nothing to do, and it is precisely because of this that everyone's attention is paralyzed, and if we can understand the mechanism, it may raise our vigilance. ”

"In my opinion, this should be the compensatory mechanism for this novel coronavirus to attack the human body. Because people will produce nerve impulses in the same environment, the receptors will sense and activate the compensatory mechanism, and the patient's heartbeat and shortness of breath will obtain more oxygen, which will work as a compensatory mechanism. As a result, the patient will not have extreme conditions such as coma or cardiac arrest. However, this compensatory mechanism is tantamount to exhausting the body's energy and obtaining more oxygen, after all, it will not last long. Once this compensation is destroyed, the patient dies instantly. I wonder if I've made my thoughts clear? ”

Dai Yunyang was sincerely amazed by Wu Hao's explanation, Wu Hao was a senior doctor after all, and he had been in the emergency department. Before this, Dai Yunyang still couldn't figure out the pathogenesis of this situation, and Wu Hao's statement was better to explain why there was a serious hypoxia but stable breathing illusion. That's because the body's compensatory mechanism is working, but this mechanism can't last long, it can lead to an instantaneous breakdown of body functions.

So Dai Yunyang nodded and said, "I agree with Director Wu's opinion. I think that since the medical records that you have just put together, there have been several patients who died suddenly, and some of them had obvious symptoms of oxygen deprivation before they died. This shows that Director Wu's analysis is reasonable, and if Director Wu's analysis is true, then we cannot dwell on the common indications of intubation. ”

"Because waiting until we see the common indications for intubation before intubating is actually dangerous for the patient. It may not be right away, but the patient may have been too far away from being seriously or critically ill. If we had been intubated earlier, we would have shortened this distance and reduced the danger to the patient. Therefore, move the cannula forward as much as possible. ”

Director Fu of the respiratory department lifted his glasses and asked Dai Yunyang: "May I ask Dr. Dai, where do you think we should move forward?" Do we have to be intubated as soon as the patient comes in? Is non-invasive breathing useless? ”

Dai Yunyang said tepidly: "That's not it. I think that we can advance to non-invasive breathing, or the condition of high-flow nasal cannula oxygen therapy cannot be significantly improved in a short period of time, or even further deteriorate, then we should perform endotracheal intubation invasive mechanical ventilation in time. ”

"What does Dr. Dai mean is that invasive ventilation and endotracheal intubation should be used immediately as long as the oxygen saturation cannot be corrected for a short period of time using non-invasive ventilation?"

That's what it means. In fact, after endotracheal intubation, nursing is not as difficult as everyone thinks, in fact, on the contrary, I think it is easier to care, and this point Nurse Xiong may have the most say. ”

Nurse Xiong generally doesn't speak in this kind of discussion, she just listens quietly. She will only say if there is something related to nursing that she needs to explain or give an opinion.

Now that she asked, she said, "Intubation care is actually not that difficult, we are confident that it will be completed, as for when the intubation will be determined." In addition, I would like to say that endotracheal intubation is indeed a high-risk procedure, and many people have concerns, and it is also an important reason for reluctance to perform endotracheal intubation, and it may be better to solve this reason. ”

Wu Hao said: "Everyone can rest assured about this, but if the attending doctor who needs endotracheal intubation, he does not need to insert it himself, or even approach." We have a special intubation knife class, which is operated by Dai Yunyang and them. They are experienced and quick to avoid the high risks associated with endotracheal intubation. ”

Everyone nodded, and indeed this was a big reason for their opposition to endotracheal intubation. After all, the fear of splashing secretions from endotracheal intubation increases the risk of coronavirus infection.

Xiong Shengnan continued: "There are always two sides to the matter, although endotracheal intubation is a high risk, but after endotracheal intubation, the ventilator forms a closed-circuit cycle, compared with non-invasive ventilators and high-flow oxygen, there will be no droplets, so it is actually relatively safer for medical staff and other patients." Therefore, as we nurses, we are actually more willing to care for patients who use ventilators to form closed-circuit circulation after tracheal intubation, after all, the probability of droplet infection in this kind of patient is much smaller and relatively safer. ”