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Nearly 700 new crown patients in the intensive care unit! Doctor in Hangzhou: Many people have respiratory distress and severe pneumonia, this posture is very important
January 04, 2023 14:39
"Grandpa, slow down, breathe in slowly, too fast..." In the COVID-19 ICU of Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Wu Xiaoqing, a rehabilitation therapist, was attached to a patient and helped him complete the treatment in the prone position.
In order to help new crown patients with high-risk factors for severe illness to better ventilate, Run Run Shaw Hospital of Zhejiang University has formed a "prone position ventilation" service team to prevent these patients from becoming critically ill.
At present, this team provides guidance and services for nearly 700 new crown patients in the hospital on prone position ventilation.
In order to cope with the "peak" of infection, Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine moved space, integrated resources, and set up a new crown intensive care unit as a transition between the emergency department and the intensive care unit. At present , nearly 700 new crown patients have been treated . Most of the people on the hospital bed were elderly people, many of them were inhaling oxygen for treatment, some of them fell asleep, and the ward seemed very quiet.
"Most patients are suffering from chest tightness, shortness of breath, respiratory distress, hypoxemia, and need oxygen therapy when they are sent to the clinic. There is lung inflammation, and a small number of them are severe pneumonia." said head nurse Zhu Xiaoying, a rehabilitation therapist at Run Run Shaw Hospital of Zhejiang University. Most of them are elderly people, most of them are in their eighties or nineties, and there are even centenarians.
When many patients were admitted to the hospital, their blood oxygen saturation was less than 95, they had shortness of breath, and their heart rate was as high as 123.
"If you don't intervene in time, it will soon develop into a critical illness and you will be admitted to the intensive care unit." Wu Xiaoqing said, " Half of these patients need prone position ventilation. "
The "Diagnosis and Treatment Program for Novel Coronavirus Pneumonia (Trial Ninth Edition)" pointed out that ordinary, severe and critical patients with high risk factors for severe illness and rapid disease progression should be given standard prone position treatment.
Simply put, the prone position is lying on your stomach. Lying on the stomach can promote the "resurrection" of the alveoli on the back, improve the exchange of blood and blood, increase the saturation of blood oxygen, and promote the discharge of sputum.
It is precisely because of this posture that the "prone position ventilation" service team composed of professional nurses and rehabilitation therapists at Run Run Shaw Hospital of Zhejiang University is also known as the "squat team".
"Lying on stomach" is the simplest, safe, economical and effective way of breathing therapy.
However, it is more labor-intensive to perform standardized prone position treatment for critically ill patients.
"We need a group of 4 people to complete such a treatment for one patient." Zhuang Yiyu, deputy director of nursing at Run Run Shaw Hospital of Zhejiang University, introduced that a complete set of operations involves assessing the patient's condition, positioning the patient, and taking good care of the oxygen on the patient's body. Pipeline, and observe the patient's complexion and vital signs changes.
On the morning of January 3, Wu Xiaoqing and colleagues in the same group performed prone position treatment for an uncle in his 80s. When the uncle was sent to the ward, his oxygen saturation was only 92, his heart rate reached 120, and he was accompanied by chest tightness and shortness of breath.
"Uncle, is your neck uncomfortable? Put your arms over and inhale slowly. It's too fast, too fast, slow down, yes, just breathe in slowly."
Wu Xiaoqing bent down, almost lying next to the uncle's ear, helping him adjust his body position, while adjusting his posture for him. Prior to this, several colleagues helped the patient turn over and adjust the lying position.
"Some patients can hear the instructions clearly and can turn over by themselves. There are also some patients like this uncle who move slowly and cannot cooperate with our instructions well. We still need a few people to turn him over."
In this case, it consumes more energy.
Generally speaking, a treatment in the prone position lasts for two hours, but most patients cannot persist and can only lie on the prone position for half an hour or an hour later, and then the members of the "squatting team" will change their positions again.
After a period of treatment in the prone position, the uncle's condition improved significantly. The oxygen saturation quickly returned to above 95, and his breathing status gradually stabilized.
At present, there are a total of 30 people in the "Papa Team" in the two campuses of Run Run Shaw Hospital of Zhejiang University.
"Through such treatment and intervention, we hope to help these patients improve their respiratory conditions and avoid developing from mild to severe." Zhuang Yiyu said.
On January 3, Grandma Liu, a 103-year-old COVID-positive patient with underlying diseases, recovered and was discharged from Wuhan Pulmonary Hospital after a week of treatment. According to experts, Grandma Liu's treatment only required a small amount of medication, moderate oxygen therapy, and mainly relied on prone position ventilation. These experiences have certain reference value for elderly patients to successfully fight against new crown infection.
On December 28 last year, the family found that Grandma Liu's body temperature was normal, but her appetite was poor. The family immediately realized that this may be due to the low sensitivity of elderly patients to the new coronavirus, which cannot rule out new coronavirus infection. Sure enough, the oxygen saturation of the old man's blood was found to be lower than 93% (the normal value is 95%~100%) through the finger pulse oxygen test. The family immediately sent him to Wuhan Pulmonary Hospital, and CT examination confirmed that infection lesions had appeared on the lungs.
According to Dr. Chen Guoxi, Grandma Liu's response to the new crown virus is similar to that of many elderly people, that is, she does not have a fever or a "blade throat", but only manifests as depressed mood, poor appetite, fatigue and lethargy. Fortunately, Grandma Liu's family found abnormalities by measuring blood oxygen saturation and sent them to the hospital in time.
"Similar to many elderly people, Grandma Liu's liver and kidney function is weak, and many drugs that have been proven to be effective against new crown infections cannot be used on her. Therefore, the elderly rarely use drugs, and mainly rely on moderate oxygen therapy and conscious prone position ventilation to improve symptoms. Among them, the effect of conscious prone position ventilation is very ideal, and the blood oxygen saturation of the elderly quickly rises to above 95, and remains stable for a long time." said doctor Chen Guoxi.
When Grandma Liu started her treatment with conscious prone position ventilation, she was unable to persist in the prone position for a long time, and she gradually got used to it with the help and comfort of the medical staff. In the next few days, except for two hours after meals and the time to get out of bed, Grandma Liu was able to maintain a prone position for at least two hours at a time.
Chen Guoxi said that in view of the good effect of prone position ventilation, it is now widely used for patients in ordinary new crown wards. This treatment requires no injections, no medicines, and no burden on patients, and only needs to maintain one posture.
Can lying down save lives? Will people with dyspnea get better if they lie on their stomachs? Netizens from all walks of life shared their methods and experiences on how to alleviate coughing and dyspnea after the "yang pass". Professor Liu Huiguo, Department of Respiratory and Critical Care Medicine, Tongji Hospital reminded that "lying on the stomach" is just a treatment method, it is not good for everyone, and it is not suitable for everyone, but if the prone position can relieve hypoxia, you can try it. This position, but still need to seek medical attention as soon as possible.
"In medicine, there is a professional term 'prone position ventilation', which may be the 'prone position treatment' in the eyes of the public." Liu Huiguo explained that prone position ventilation is mainly for mechanically ventilated (ie intubated) patients, using medical operations , keep the patient in a prone position for treatment. Especially it plays a vital role in the treatment of severe respiratory failure, moderate/severe acute respiratory distress syndrome (ARDS). That's because in the prone position, the pressure on the lung tissue from the abdominal and heart organs is reduced, and the airflow is distributed more evenly in the lungs, thereby achieving the purpose of improving oxygenation.
According to Liu Huiguo, in the new coronavirus pneumonia diagnosis and treatment plan (trial version 9), prone position treatment is recommended in the treatment, mainly for ordinary, severe or critical patients with high risk factors for severe disease and rapid disease progression. the treatment. However, this treatment is not the same treatment, and it is not suitable for everyone. Lying on the stomach is not a correct lying posture, and lying on the stomach for a long time is not conducive to the discharge of sputum. Elderly patients will also Can't stand it. When the oxygen saturation of elderly patients is very low, before arriving at the hospital in time, if the oxygen saturation at home increases, this position can be used to help relieve the symptoms of hypoxia, but it is only Only temporary means and medical intervention can fundamentally solve the problem.
Precautions for awake prone position:
In fact , frequent coughing after "yang" does not represent the aggravation of the new coronavirus infection. There are three possible reasons:
One is that the virus has invaded the respiratory tract, including the lungs, and local inflammation will lead to coughing;[/COLOR]
The second is secondary bacterial infection, and even purulent sputum and sore throat;
The third is that the repair of the upper respiratory tract requires a process. When the external environment, air, and irritants damage the airway mucosa, its sensitivity will increase, and it will also lead to frequent coughing.
Coughing is a reflex defense action of the human body. Most of them are post-infection cough, which is a self-limiting cough. Some people will gradually relieve it in about 7-10 days, and some people may continue to relieve it for 2-3 weeks or even 1 month. Liu Huiguo suggested that they can be dealt with separately:
zhttps://news.sina.com.cn/s/2023-01-04/doc-imxyzfyc7742793.shtml?cre=tianyi&mod=pcpager_china &loc=16&r=0&rfunc=78&tj=cxvertical_pc_pager_spt&tr =174
January 04, 2023 14:39
"Grandpa, slow down, breathe in slowly, too fast..." In the COVID-19 ICU of Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Wu Xiaoqing, a rehabilitation therapist, was attached to a patient and helped him complete the treatment in the prone position.
In order to help new crown patients with high-risk factors for severe illness to better ventilate, Run Run Shaw Hospital of Zhejiang University has formed a "prone position ventilation" service team to prevent these patients from becoming critically ill.
At present, this team provides guidance and services for nearly 700 new crown patients in the hospital on prone position ventilation.
Most patients are elderly
have respiratory distress
In order to cope with the "peak" of infection, Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine moved space, integrated resources, and set up a new crown intensive care unit as a transition between the emergency department and the intensive care unit. At present , nearly 700 new crown patients have been treated . Most of the people on the hospital bed were elderly people, many of them were inhaling oxygen for treatment, some of them fell asleep, and the ward seemed very quiet.
"Most patients are suffering from chest tightness, shortness of breath, respiratory distress, hypoxemia, and need oxygen therapy when they are sent to the clinic. There is lung inflammation, and a small number of them are severe pneumonia." said head nurse Zhu Xiaoying, a rehabilitation therapist at Run Run Shaw Hospital of Zhejiang University. Most of them are elderly people, most of them are in their eighties or nineties, and there are even centenarians.
When many patients were admitted to the hospital, their blood oxygen saturation was less than 95, they had shortness of breath, and their heart rate was as high as 123.
"If you don't intervene in time, it will soon develop into a critical illness and you will be admitted to the intensive care unit." Wu Xiaoqing said, " Half of these patients need prone position ventilation. "
What is Prone Positioning Ventilation Therapy?
The "Diagnosis and Treatment Program for Novel Coronavirus Pneumonia (Trial Ninth Edition)" pointed out that ordinary, severe and critical patients with high risk factors for severe illness and rapid disease progression should be given standard prone position treatment.
Simply put, the prone position is lying on your stomach. Lying on the stomach can promote the "resurrection" of the alveoli on the back, improve the exchange of blood and blood, increase the saturation of blood oxygen, and promote the discharge of sputum.
It is precisely because of this posture that the "prone position ventilation" service team composed of professional nurses and rehabilitation therapists at Run Run Shaw Hospital of Zhejiang University is also known as the "squat team".
"Lying on stomach" is the simplest, safe, economical and effective way of breathing therapy.
After prone positioning treatment,
Uncle in his 80s breathes steadily
However, it is more labor-intensive to perform standardized prone position treatment for critically ill patients.
"We need a group of 4 people to complete such a treatment for one patient." Zhuang Yiyu, deputy director of nursing at Run Run Shaw Hospital of Zhejiang University, introduced that a complete set of operations involves assessing the patient's condition, positioning the patient, and taking good care of the oxygen on the patient's body. Pipeline, and observe the patient's complexion and vital signs changes.
On the morning of January 3, Wu Xiaoqing and colleagues in the same group performed prone position treatment for an uncle in his 80s. When the uncle was sent to the ward, his oxygen saturation was only 92, his heart rate reached 120, and he was accompanied by chest tightness and shortness of breath.
"Uncle, is your neck uncomfortable? Put your arms over and inhale slowly. It's too fast, too fast, slow down, yes, just breathe in slowly."
Wu Xiaoqing bent down, almost lying next to the uncle's ear, helping him adjust his body position, while adjusting his posture for him. Prior to this, several colleagues helped the patient turn over and adjust the lying position.
"Some patients can hear the instructions clearly and can turn over by themselves. There are also some patients like this uncle who move slowly and cannot cooperate with our instructions well. We still need a few people to turn him over."
In this case, it consumes more energy.
Generally speaking, a treatment in the prone position lasts for two hours, but most patients cannot persist and can only lie on the prone position for half an hour or an hour later, and then the members of the "squatting team" will change their positions again.
After a period of treatment in the prone position, the uncle's condition improved significantly. The oxygen saturation quickly returned to above 95, and his breathing status gradually stabilized.
At present, there are a total of 30 people in the "Papa Team" in the two campuses of Run Run Shaw Hospital of Zhejiang University.
"Through such treatment and intervention, we hope to help these patients improve their respiratory conditions and avoid developing from mild to severe." Zhuang Yiyu said.
Liver and kidney function is weak, many medicines are useless
Doctors try "awake prone position ventilation"
103-year-old new crown patient recovered and discharged from hospital
On January 3, Grandma Liu, a 103-year-old COVID-positive patient with underlying diseases, recovered and was discharged from Wuhan Pulmonary Hospital after a week of treatment. According to experts, Grandma Liu's treatment only required a small amount of medication, moderate oxygen therapy, and mainly relied on prone position ventilation. These experiences have certain reference value for elderly patients to successfully fight against new crown infection.
On December 28 last year, the family found that Grandma Liu's body temperature was normal, but her appetite was poor. The family immediately realized that this may be due to the low sensitivity of elderly patients to the new coronavirus, which cannot rule out new coronavirus infection. Sure enough, the oxygen saturation of the old man's blood was found to be lower than 93% (the normal value is 95%~100%) through the finger pulse oxygen test. The family immediately sent him to Wuhan Pulmonary Hospital, and CT examination confirmed that infection lesions had appeared on the lungs.
According to Dr. Chen Guoxi, Grandma Liu's response to the new crown virus is similar to that of many elderly people, that is, she does not have a fever or a "blade throat", but only manifests as depressed mood, poor appetite, fatigue and lethargy. Fortunately, Grandma Liu's family found abnormalities by measuring blood oxygen saturation and sent them to the hospital in time.
"Similar to many elderly people, Grandma Liu's liver and kidney function is weak, and many drugs that have been proven to be effective against new crown infections cannot be used on her. Therefore, the elderly rarely use drugs, and mainly rely on moderate oxygen therapy and conscious prone position ventilation to improve symptoms. Among them, the effect of conscious prone position ventilation is very ideal, and the blood oxygen saturation of the elderly quickly rises to above 95, and remains stable for a long time." said doctor Chen Guoxi.
When Grandma Liu started her treatment with conscious prone position ventilation, she was unable to persist in the prone position for a long time, and she gradually got used to it with the help and comfort of the medical staff. In the next few days, except for two hours after meals and the time to get out of bed, Grandma Liu was able to maintain a prone position for at least two hours at a time.
Chen Guoxi said that in view of the good effect of prone position ventilation, it is now widely used for patients in ordinary new crown wards. This treatment requires no injections, no medicines, and no burden on patients, and only needs to maintain one posture.
news+
Prone Positioning Therapy Isn't For Everyone
If you experience these symptoms, seek medical attention as soon as possible
Can lying down save lives? Will people with dyspnea get better if they lie on their stomachs? Netizens from all walks of life shared their methods and experiences on how to alleviate coughing and dyspnea after the "yang pass". Professor Liu Huiguo, Department of Respiratory and Critical Care Medicine, Tongji Hospital reminded that "lying on the stomach" is just a treatment method, it is not good for everyone, and it is not suitable for everyone, but if the prone position can relieve hypoxia, you can try it. This position, but still need to seek medical attention as soon as possible.
Prone Positioning Therapy Isn't For Everyone
"In medicine, there is a professional term 'prone position ventilation', which may be the 'prone position treatment' in the eyes of the public." Liu Huiguo explained that prone position ventilation is mainly for mechanically ventilated (ie intubated) patients, using medical operations , keep the patient in a prone position for treatment. Especially it plays a vital role in the treatment of severe respiratory failure, moderate/severe acute respiratory distress syndrome (ARDS). That's because in the prone position, the pressure on the lung tissue from the abdominal and heart organs is reduced, and the airflow is distributed more evenly in the lungs, thereby achieving the purpose of improving oxygenation.
According to Liu Huiguo, in the new coronavirus pneumonia diagnosis and treatment plan (trial version 9), prone position treatment is recommended in the treatment, mainly for ordinary, severe or critical patients with high risk factors for severe disease and rapid disease progression. the treatment. However, this treatment is not the same treatment, and it is not suitable for everyone. Lying on the stomach is not a correct lying posture, and lying on the stomach for a long time is not conducive to the discharge of sputum. Elderly patients will also Can't stand it. When the oxygen saturation of elderly patients is very low, before arriving at the hospital in time, if the oxygen saturation at home increases, this position can be used to help relieve the symptoms of hypoxia, but it is only Only temporary means and medical intervention can fundamentally solve the problem.
Precautions for awake prone position:
- Suspend eating 2 hours before prone position; patients with nasogastric tube need to withdraw the residual stomach, and nasointestinal tube can be indwelling.
- 2-3 pillows are needed: the first pillow is placed under the forehead and the second pillow is placed on the chest.
- Pay attention to reserve a space for the oxygen tube and mask to facilitate adjustment and observation.
- For pregnant women, obese patients, and patients with abdominal wounds, use the third pillow to pad the hips, and try to empty the abdomen to avoid pressure.
- Keep your body relaxed, don't strain your elbows or shoulders, and avoid plank or push-up positions.
- Pay attention to the appropriate temperature in the ward, and avoid wearing too thick for patients.
- It can be carried out in sections within a day, about 2 hours each time. The recommended time for prone position: 09:00-11:30, 14:00-16:30, 20:00-22:00, 23:00-06:00 .
When should I seek medical attention?
In fact , frequent coughing after "yang" does not represent the aggravation of the new coronavirus infection. There are three possible reasons:
One is that the virus has invaded the respiratory tract, including the lungs, and local inflammation will lead to coughing;[/COLOR]
The second is secondary bacterial infection, and even purulent sputum and sore throat;
The third is that the repair of the upper respiratory tract requires a process. When the external environment, air, and irritants damage the airway mucosa, its sensitivity will increase, and it will also lead to frequent coughing.
Coughing is a reflex defense action of the human body. Most of them are post-infection cough, which is a self-limiting cough. Some people will gradually relieve it in about 7-10 days, and some people may continue to relieve it for 2-3 weeks or even 1 month. Liu Huiguo suggested that they can be dealt with separately:
- When the cough is very severe , compound methoxyphenamine capsules can be used, but patients with high blood pressure should use them with caution, or Suhuang Zhike Capsules, etc. for cough relief;[/COLOR]
- When there is excessive phlegm and strenuous coughing, you can use phlegm-resolving drugs, and take Chernobyl Limonene Enteric-Coated Capsules and Ambroxol Hydrochloride Oral Solution under the guidance of a doctor.
zhttps://news.sina.com.cn/s/2023-01-04/doc-imxyzfyc7742793.shtml?cre=tianyi&mod=pcpager_china &loc=16&r=0&rfunc=78&tj=cxvertical_pc_pager_spt&tr =174