Famous Among Top Surgeons in the 90s-Chapter 1987: As Expected
What makes lung atelectasis so frightening?
The alveoli do not open and there is no gas exchange, indicating that the patient is severely hypoxic, potentially leading to suffocation and death. These symptoms of hypoxic suffocation are called Respiratory Distress Syndrome, or RDS in English. In adult patients, it’s known as adult-type RDS, abbreviated as ARDS, with an added A. In newborns, it’s called Neonatal Respiratory Distress Syndrome, NRDS, with an added N. The reason these two are separated is because the causes of respiratory distress syndrome in adults and newborns are quite different.
In adult ARDS, as illustrated by the memorable case of SARS, the primary cause is severe infection. In patients with severe infection, the virus inactivates a large amount of pulmonary surfactant, abbreviated as PS, on the surface of the alveoli, causing them to collapse.
Simultaneously, a large amount of mucus can obstruct the bronchial passages, causing mechanical obstruction that cannot be cleared, ultimately leading to severe hypoxia and death of the patient.
The treatment approach is definitely to first fight the infection. Without specific antiviral drugs, the effectiveness of anti-infection treatments is severely compromised, leaving doctors with only physical methods like bronchoscopy and chest physiotherapy to expel phlegm. These remaining life-saving methods become particularly important in rescuing such patients, requiring substantial nurse assistance in the ward. Beyond that, one can only rely on the patient’s immune system to fight infection. However, relying on the patient’s immune system comes with another fatal issue, known as the cytokine storm, which is also a major cause of death in such patients.
Thus, it is clear that current medical measures for adult respiratory distress syndrome patients are limited, and clinical doctors are always very apprehensive. When faced with new respiratory virus infections like SARS, only more distant, ancient measures like isolation can be taken. There is no medicine to treat it.
Aside from infections, adult respiratory distress syndrome can also be caused by trauma and foreign body aspiration, which are similarly dangerous with high mortality rates.
In comparison, NRDS, or Neonatal Respiratory Distress Syndrome, primarily occurs in premature infants. The cause of this condition in such infants is relatively singular, making it appear relatively easier to treat.
To understand the source of Neonatal Respiratory Distress Syndrome, one must first understand the mechanism by which a normal baby leaves the mother’s body. Firstly, when a fetus is inside the Uterus, it does not breathe on its own, and the lungs do not inflate. A newborn baby needs the pulmonary surfactant provided by the mother to allow the lungs to inflate automatically. Premature infants, having left the mother early, lack this gift and are missing this substance, causing the alveoli to be unable to inflate and leading to breathing difficulties.
Going back to the initial discussion where Doctor Hu mentioned lung-promoting injections, the most commonly used drug in clinical practice is Dexamethasone, a type of steroid, which utilizes this mechanism to induce fetal lung type II cells to produce pulmonary surfactant PS, ultimately preventing white lung and avoiding respiratory distress.
Currently, due to the sudden situation, the doctor was unable to administer the lung-promoting injection to this new mother in advance, so the premature newborn having respiratory distress symptoms was, as Doctor Hu indicated, foreseeable by the medical staff.
Since it is known that the baby is lacking this substance, leading to respiratory distress, can the baby directly be given pulmonary surfactant? Of course, it can be. The problem is, where would a small health clinic have such a thing?
This drug is expensive. General hospitals that do not have a specialized neonatology department typically do not have such specialized and expensive medications.
