SAHZU SPECIALISTS AT HANGZHOU (UP) SAHZU'S ICU AT WUHAN UNION (MIDDLE)SAHZU MEDICAL AID TEAM (DOWN)

SAHZU multidisciplinary specialist team and SAHZU medical aid team at Wuhan discussed about the treatment plan of a critically ill patient diagnosed with the novel coronavirus-infected pneumonia (NCIP) who is currently taken care by the SAHZU medical aid team at Wuhan Union Hospital through video conferencing system on Feb 21.

Dr. LUO Rubin, associate chief physician from SHAZU General Surgery ICU, briefed the condition of the patient. Patient is a 47-year-old female who began to have coughs and fever about 20 days ago after shopping at a food market. Her CT scan shew infections in both lungs and PCR was tested positive. The patient was then prescribed with medications and asked to rest at home. But the patient’s coughing aggravated and she began to have chest tightness. She was admitted to ICU the second day after SAHZU medical aid team arrived.

Because of her chronic condition of asthma, despite the high flow oxygen therapy she was receiving, patient’s condition kept worsening. The blood oxygen level of the patient was only about 90% even when she was calm and relaxed and sometimes could be as low as 75%. Dr. ZHANG Bin, associated physician from SAHZU respiratory medicine, performed the bronchoscopy-assisted endotracheal intubation through nose and connected the patient to the respiratory machine on Feb. 19.

But the next two days evaluation suggested patient condition continue progressing as her oxygen level was still decreasing and hypercapnia appeared. Therefore, considering the patient’s critical condition and chest CT images, the medical aid team was wondering if extracorporeal membrane oxygenation (ECMO) could be an option of early intervention for the patient.

After reading patient’s test results and CT images, SAHZU experts had a serious discussion about the case. Chair of SAHZU Radiology Prof. ZHANG Minming pointed out that the three-times chest CT scan demonstrate the lesions in patient’s lungs have developed from large ground-glass opacity to grid-like or stone-paving like or even fibrous changes, which is a very typical sign in NCIP patients. The patient is in critical condition as the lesions have taken up 70% of her lungs. But the fibrosis is not irreversible. CT imaging in multiple cases has shown that the fibrous lesions caused by damaged and collapsed alveoli can be reversed. “We should see hope in this patient.” said Prof. ZHANG.

Chair of SAHZU Respiratory Medicine Prof. SHEN Huahao asked about the details of steroids now applied in the patient, then indicated the pulmonary fibrosis in some patients can be reversed based on observation of “both SARS patients and NCIP patients”.

Chair of SAHZU Emergency Medicine Prof. ZHANG Mao and Chair of SAHZU General ICU Prof. HUANG Man, however, paid their attention on the patient’s lab results related to infection and heart-lung functions, worrying about possible complications. Chair of SAHZU Neuro ICU Prof. HU Yinghong concentrated on the dose of sedation medication.

In the end, Prof. SHEN Huahao concluded the discussion. He summarized that there are no signs that the patient’s heart, liver, kidney functions have been impaired, which leaves the lungs to be the main problem area. He suggested that the patient could still stay on the respiratory machine while the team should adjust the steroid dose, strictly control the fluids intake and output and closely monitor the patient condition to protect her other organ functions. “Respiratory machine should work fine for the patient at this moment. There is no need for ECMO yet.” Prof. ZHANG Mao added.

SAHZU President Prof. WANG Jian’an, CPC Party Secretary Dr. CHEN Zhengying, Vice President Prof. HUANG Jian, Vice President Prof. DING Kefeng, Vice President of Binjiang Campus Prof. WANG Liangjing also sit in the conference.

A 171-member SAHZU medical aid team took over the entire orthopedic ward in the cancer center of Wuhan Union Hospital immediately after arriving at the site on Feb. 14. The ward was quickly transformed into a temporary intensive care unit with upgraded facilities and revised protocols. A total of 39 critical patients have been treated in SAHZU’s Wuhan ICU, 9 of whom have been transferred out of ICU after their symptoms have been relieved.