Chapter 3167: with translation of chapter title

Because it was in the System Operating Room, Zheng Renye had no particular anxiety. This was an advantage incomparable to others, and Zheng Ren had already become accustomed to it. He silently watched the condition of the experimental subject deteriorate, and began measuring various values.

The test results indicated that the experimental subject had symptoms of metabolic acidosis and acute renal failure.

During ECMO use, gas embolism may occur, and Zheng Ren knew this. It is estimated that the gas embolism blocked the renal artery, leading to cases where the surgery failed before it was even completed.

Being able to detect it is fine; Zheng Ren remained calm. The significance of the System Operating Room lies here: to discover problems in advance and research how to avoid such situations as much as possible.

After confirming the kidney had a problem, Zheng Ren finished the lung transplant surgery, but instead of leaving the System Operating Room, he performed a renal angiography on the experimental subject.

The final conclusion proved Zheng Ren's judgment—gas embolism.

After ECMO was set up, liver and kidney function should improve, because ECMO can improve perfusion of peripheral organs.

Looking for similar data in journals, relevant information was scarce, so Zheng Ren could only rely on the limited data plus his own imagination to make judgments.

Deterioration of kidney function could be a sign of ECMO malfunction, or it could indicate that the patient already had kidney disease. After trying several methods and discussing with Lao He, Zheng Ren finally decided to make continuous renal replacement therapy an independent circuit outside the ECMO system to avoid gas embolism.

The causes of persistent metabolic acidosis could be inadequate perfusion of any organ, tissue necrosis, or distal limb infarction. Oxygenator failure can manifest as massive hemolysis. Distinguishing hematuria, disseminated intravascular coagulation, and hemolysis requires emergency diagnostic tests; continuous measurement of values during surgery and timely treatment are crucial.

One problem after another was solved, and Zheng Ren tirelessly pulled Lao He into research.

Each time a problem was confirmed and resolved, Zheng Ren discovered that, besides renal failure due to gas embolism, there was also a 15% chance of developing acute liver failure when using ECMO.

Because Xiao Shitou had just completed two liver cancer transarterial embolization procedures, his liver function was relatively poor. Liver failure is also a major concern in surgery. Zheng Ren did not want to show off his skills; he did not want to perform a liver transplant at the same time as the lung transplant.

Even a single organ transplant would be too much for Xiao Shitou to bear, let alone more organs.

Finally, Zheng Ren and Lao He agreed to measure liver function every ten minutes during surgery; if Xiao Shitou, despite appropriate ECMO flow and blood pressure, continued to develop persistent bilirubin elevation or acute liver enzyme elevation, a molecular adsorbent recirculating system for liver dialysis must be used.

"Lao He, do we have intraoperative liver dialysis?" Zheng Ren asked.

"None, only Xiehe and Di Du Hepatobiliary in Di Du have it." Lao He said, "Our volume of liver surgery is not as high as theirs, and this situation is rare, so the equipment hasn't been introduced yet."

Zheng Ren also did not hesitate, and made a phone call to Zhou Chun Yong.

Borrowing a piece of equipment for use, returning it after borrowing—Director Bao Longtao of the Di Du Hepatobiliary Institute would surely not make things difficult over such a minor matter.

Lao He felt especially helpless; in his view, even if there were liver problems, there would still be time to deal with them later. But Zheng Lao Ban put on an air of insisting on perfecting the surgery, so he didn't say much more.

After nearly ten hours of discussion, round after round of brainstorming, Lao He had been completely drained by Zheng Lao Ban.

Seeing Zheng Lao Ban full of energy mounting the operating table to conduct surgical training, Lao He held a stack of twelve A4 pages of notes and slowly closed his eyes.

Just anesthesia, ECMO, and extracorporeal circulation already involve so many details to watch; as for the surgery itself, there are likely even more points to pay attention to.

"Lao He, would you like to drink some Red Bull?" Lin Ge's voice came.

"Ah? Section Chief Lin, how come you're here?" Lao He was startled; it's already this late—why would Section Chief Lin even need to ask? He is also preparing to stay overnight at the community hospital to handle logistics.

During Section Chief Mao's tenure, the Science and Education Department was almost invisible to clinical work, aside from taking kickbacks from resident physicians; it basically did nothing else proper. A stale smell pervaded it; when the Science and Education Department was mentioned, clinical doctors would frown outright.

This was part of Section Chief Lin's duties, but Lao He still wasn't used to it.

He wanted to greet Lin Ge, but his eyelids felt as if they were glued together, and he could only open them with great effort.

"If you can't go on, just go back and sleep." Lin Ge advised, "I see you're mentally exhausted; you're probably done for tonight. Staying here won't help; efficiency would actually be lower. This isn't a one-day thing—I see Zheng Lao Ban's intention; this is a marathon."

"Ah, but Zheng Lao Ban is young, healthy, and full of energy." Lao He glanced at Zheng Ren standing silently under the shadowless lamp, sighed, and said, "My old arms and legs really can't keep up."

"What were you just discussing?"

"Zheng Lao Ban walked me through the anesthesia work from start to finish." Lao He said, "The tube model, insertion depth, ventilator frequency, tidal volume, end-expiratory pressure… then came the various points to note during ECMO, as well as preparations for kidney and liver dialysis."

"Usually…"

"Section Chief Lin, how high are Zheng Lao Ban's demands?" Lao He said, "The hepatobiliary department has applied several times to introduce intraoperative liver dialysis equipment, but it still hasn't been approved. Zheng Lao Ban is borrowing equipment from Di Du Hepatobiliary to ensure everything is foolproof."

"I heard that, and I was just about to ask you—does borrowing this equipment make sense?" Lin Ge lowered his voice and asked.

"Of course it's meaningful; if bilirubin rises during surgery, immediately putting the patient on liver dialysis is far more effective than postoperative symptomatic treatment." Lao He said, "But the significance… is just that; if it were someone else, they'd probably just make do. The surgery wouldn't be delayed much, and doing dialysis intraoperatively is less effective than doing it afterward. Moreover, few people know about intraoperative kidney dialysis, so this is quite a cutting-edge approach."

"Look at what you're saying." Lin Ge laughed.

"Section Chief Lin, I'm not joking." Lao He said seriously, "If you don't believe me, ask any clinical doctor—when they hear dialysis they think of kidneys, and truly few know about intraoperative liver dialysis."

Lin Ge nodded, and he raised the incident's severity level a notch.

"Whatever Zheng Lao Ban cares about, we must care about too—there's nothing more to say. For a possible problem, he spared no effort to go to Di Du Hepatobiliary to borrow equipment; the amount of heart he put in doesn't need further explanation."

"If Zheng Lao Ban weren't roughly the same age as the young patient, Lin Ge would even think that the young patient was Zheng Lao Ban's illegitimate child. If it weren't his own son, who would be willing to go to such lengths, even having to use connections, to prepare for surgery and treatment?"

"Treating patients like family"—Director Yan says this at every hospital weekly meeting. But truly few doctors can actually achieve treating patients like family.

"Zheng Lao Ban… even Lin Ge thinks he's gone too far."