6.2. Treatment of severe and critical cases
  1. The principle of treatment: on the basis of symptomatic treatment, actively prevent and treat complications, treat basic diseases and secondary infection timely.
  2. Respiratory support: A. oxygen therapy given by the nasal catheter or mask and assess the effect of oxygen inhalation. B. High flow oxygen therapy or noninvasive mechanical ventilation when the respiratory distress or hypoxemia cannot be alleviated after standard oxygen therapy. Intubation and invasive mechanical ventilation, if the condition does not improve or even worsen. C. Lung protective ventilation strategies: High positive end-expiratory pressure (PEEP) can be appropriately used to keep the airway warm and humid.
  3. Circulation support: based on adequate fluid resuscitation, improve microcirculation, closely monitor the changes of blood pressure, heart rate and urine volume of patients, as well as the surplus of lactate and alkali, and apply hemodynamic monitoring if necessary.
  4. Rescue treatment: Rescue treatment: applying lung expansion for patients with severe ARDS. Using extracorporeal membrane oxygenation (ECMO) soon as possible, when the mechanical ventilation has no effect. ECMO indications: A. FiO2 > 90%, oxygenation index is less than 80mmHg for more than 3-4 hours; B. use VV-ECMO mode for the patients with airway platform pressure ≥35cm H2O and simple respiratory failure. if circulatory support is needed, VA-ECM0 mode is selected. When the basic diseases are under control and the cardiopulmonary function shows signs of recovery, the machine withdrawal test can be started.
  5. Renal failure and renal replacement therapy: search for the cause of renal function damage. Pay attention to the balance of the fluid, acid-base and electrolyte, and the supplement of heat and trace elements. Continuous renal replacement therapy (CRRT) can be used in the severe patients.
  6. Other treatments: Chinese medicine treatment, convalescent plasma therapy, blood purification treatment, immunotherapy and so on.